Ann Widdecombe – 2001 Speech on Policing

Below is the text of the speech made by Ann Widdecombe, the then Shadow Home Secretary, on 15 February 2001.

Police officers tell me that they cannot do their job effectively. They joined the police to fight crime and catch criminals – and that is what the public want them to do. Instead, they spend hour upon hour filling in forms – and judging from letters to Police Review and surveys of individual forces, the police believe that most of the bureaucracy is unnecessary. The result is rock bottom morale, which the Chairman of the Police Federation says is the worst he has ever seen.

The public want the police to police. So do we. The police must police.

Forces up and down the country complain of being overwhelmed by the bureaucracy of the Best Value system introduced by this Government. To give you an idea of the order of magnitude, the Chief Constable of Lincolnshire has estimated that it costs £400,000, and in Norfolk £200,000. Today, I can announce that we will review Best Value with the aim of radically reforming, or, if necessary, abolishing the current exercise. No wonder a Chief Constable claims that forces are ‘sinking under a sea of targets and measures’. There are dozens of performance indicators from Best Value alone, before any others are taken into account. Surely we can create a more focused system.

We agree with the police and the public that the police officers should be able to do their job. That’s why today we are putting forward proposals to let the police get on with policing.

It is because of bureaucracy that child curfew orders and anti-social behaviour orders have been so unworkable and have failed.

I have lost count of the number of times police have told me that they can spend up to five hours or more processing a single shoplifter through custody. That is a patent nonsense, and where that happens, the custody function must be reformed or removed.

We will have a completely different approach to that of the present Government. We will put more police on the beat and make sure that the public have the reassurance of more visible policing. For example, our ‘Cops in Shops’ proposals mean that officers will be able to spend time doing their paperwork in the community – for example at special posts in local businesses – providing an increased police presence.

We will also, in co-operation with the police, hold a root and branch review of police functions with a view to taking away non-essential work. The obvious example is escorting wide loads up motorways. But it isn’t just a question of what they need not do – it is also a question of making more efficient what they must do. For example, why should police officers waste hours and hours at courts without actually giving evidence?

The police can only police if we set them free to do it, and if we really listen when they tell us that they have insufficient powers. Last year, we put forward proposals to strengthen the law against sex offenders which were first suggested by serving police officers. Some of these became law. Some did not. Conservatives will be tabling amendments to this year’s Criminal Justice Bill to give police powers that they have told us they need – on paedophiles who prey on children in internet chatrooms, and ensuring that the laws against opium dens also apply to crack houses.

Cutting back on bureaucracy. Reversing Labour’s cuts in police numbers and getting more officers back out on the streets. Letting the police get on with policing and giving them the powers they need to do it. That’s common sense.

Michael Portillo – 2001 Speech on Taking 1 Million Pensioners Out of Taxation

Below is the text of the speech made by Michael Portillo, the the Shadow Chancellor of the Exchequer, on 12 February 2001.

Last week, we announced that the next Conservative Government would implement the most radical reform of the taxation on savings in a generation. Our proposals have since been widely welcomed. Those proposals help pensioners and we welcome that. But there are approximately 17 million savers, and about 4 million pensioners who pay tax, so actually the largest number of gainers from our savings tax change are younger people.

Today I will explain an important measure to be implemented by the next Conservative Government directed particularly at pensioners that will ensure that they pay less tax than under Labour.

Many of the reasons for reducing tax on pensioners spring from the same ideas which inspire our proposals on savings. We want to simplify the system. We want to give pensioners back their dignity. And we want to encourage people to do the right thing during their working lives, and to feel when they retire that they were rewarded for doing the right thing.

We think it is better if pensioners are left with more of their own money to spend as they wish, rather than rely on Gordon Brown’s complicated means-tested benefits and credits which are paid for by the stealth taxes he’s imposed on the poorest in society.

We want to make it worth people’s while to save and build up a pension fund during their working lives, because they can be confident that they won’t be penalised for doing so when they retire.

We have already proposed to reform the rules governing the purchase of pension annuities, following the recommendations in the Oonagh McDonald Report. Once someone reaches 75, they currently have to use all of the money in their pension fund to purchase an annuity. For many pensioners, that represents a bad deal. So we think, instead, that they should just have to ensure that they have sufficient income to keep themselves independent of the state. They would be free to use the balance in their pension fund as they choose.

But we also want to make the tax system simpler and fairer for older people by taking hundreds of thousands of the poorest taxpaying pensioners out of tax altogether.

So today I can confirm that the next Conservative Government, at a cost of £350 million, will by 2003-04 take approximately 400,000 pensioners over the age of 75 out of tax, by increasing the Age-Related Personal Allowance by £2000. Pensioners who are over 75 and who have incomes between £9,570 and £17,000 will gain £440 a year from the plans.

No-one will lose out from these proposals, but because the Additional Age Allowance is gradually tapered away as you move up the income scale, over-75s with an income in excess of £24,330 will not gain.

Helping the over-75s is a good start. But we want to go further than that. So today I can announce that the next Conservative Government will increase personal allowances for the over 65s by £2,000 as well. This measure will take a further 600,000 pensioners out of tax completely at an additional cost of £600 million.

In summary, therefore, we are proposing to take 1 million pensioners out of tax altogether at a cost of up to £ 950 million. Many more pensioners earning up to £24,000 will gain as much as £440 a year under our plans and pay about £8.50 a week less tax.

Last week we announced that the vast majority of the 17 million households with savings income will be taken out of tax on their savings. This week, we announce the release of a million people from income tax altogether. These measures will generate enormous savings in the cost of government.

As with our proposals for the changes to savings tax, these measures will be implemented by the financial year 2003-04 and paid for out of the £8 billion of public expenditure savings compared to Labour’s plans which we have already identified. We have now spelt out tax cuts amounting to £4 billion of the £8 billion total.

As I pointed out last week, in the short term Gordon Brown may have money to give away as tax cuts in the forthcoming budget. If he does have money to cut taxes, he should do so. But even so he would be giving back only a tiny part of what he has already taken in extra taxes. Our £8bn of tax cuts by 2003-04 is in addition to anything Labour can offer in the next few weeks. That is because we have created extra room by making £8bn of savings to Labour’s plans. That is scope for tax cutting above and beyond whatever can be afforded in the short term in the coming budget.

At present a million pensioners have to pay tax on small amounts of earnings. Their earnings do not justify Income Tax, considering that they are approaching the end of their opportunities to work and earn. Collecting these amounts involves pensioners and civil servants in pointless administration. It discourages savings and draws people into means testing quite unnecessarily.

There is a better way. Let people keep more of what is theirs. With the Conservatives people will keep more of their own money.

Michael Portillo – 2001 Speech to the Institute of Directors in Wales

Below is the text of the speech made by Michael Portillo, the then Shadow Chancellor of the Exchequer, at the Institute of Directors conference in Wales on 20 April 2001.

With economic uncertainty growing, with major companies issuing profit warnings and stock markets fluctuating across the world, Gordon Brown’s economic plans look imprudent. Events in the United States, the continuing chronic situation in Japan, and revised growth forecasts for ‘euroland’ emphasise that the economic future is uncertain.

We Conservatives have been right to argue that Gordon Brown’s economic policies of higher tax, higher regulation and higher government spending are making Britain less competitive.

Many of us have come to think of Britain as being a good place from which to do business. We increasingly trade on a reputation, especially relative to our continental neighbours, for low taxes, a flexible labour market, and a healthy climate for enterprise. But every day under Labour it becomes less true. Step by step Britain is becoming a less enterprising economy. The need for reform is constant.

The world has not stood still during the last four years. One of the very marks of success of the British economy over the last two decades – the fact that our reforms have been taken up all over the world – has, ironically, eroded our advantage.

Take tax. The 2001 Budget locked-in the higher tax burden – equivalent to 10p on the basic rate of income tax – that Gordon Brown has imposed in his first four years. Tax as a proportion of national income has risen three percentage points from 35.2 to 38.2 per cent or £30bn –under Labour. At this rate, if we have another four years of Labour the 40 per cent barrier will be broken.

Governments across the world, and increasingly across the political spectrum, share the view that high and rising levels of taxation are fatal to enterprise. Most people accept that high taxes crowd out the private sector and reduce incentives for success. Our competitors – in America certainly, but also in France, Germany and Spain – are all giving tax cuts a priority as a key to prosperity. I`m not sure that we in Britain have fully woken up to the significance of the ground that we are losing. When will ‘Red Tape Tony’, as the US refers to our Prime Minister, begin genuinely to understand that the UK cannot afford to swim against the global tide of lower taxes and lighter regulations?

PriceWaterhouseCoopers, in a recent study, showed that two-thirds of the tax advantage we enjoyed over our European competitors in the mid-1990s has now been eroded. And the gap between Britain and low-taxed United States is growing – by 2001/02 our tax burden will be around 8.5% above that of the US.

Business has borne much of the brunt of the Chancellor’s stealth taxes. Despite the emerging global consensus for tax cuts, Mr Blair and Mr Brown have chosen to increase the tax burden by £5 billion a year on business. This has involved increasing the tax on dividends, changing Corporation Tax so that more money is paid out to the Treasury now, increasing fuel tax and the tax on property purchases, and introducing new taxes like IR35 which threaten to decimate the IT contracting sector, and the Climate Change Levy which will do nothing to improve the environment but will hit manufacturing extremely hard. This year’s Budget contains another new tax on business – a construction tax which could cost thousands of jobs and which we will be opposing when it is debated in Parliament next week.

The Government has also massively increased red tape. There is always pressure on governments to address political concerns by imposing new regulations on firms. But this Government seems to have let out all the stops, introducing 3,865 new regulations last year. The overall bill for red tape, according to an IoD survey has gone up by £5bn a year under Labour.

Equally, with the labour market the Government has, without great fanfare, started giving trades unions significant new powers – reversing the trend of the last 20 years.

The Chancellor is not just dragging the tax and regulatory systems in the wrong direction. Mr Brown’s welfare reforms, far from reducing cost and complexity and making work pay, actually increase bureaucracy and make working harder pay less. New figures reveal that 40 per cent – almost one in two – people in this country will soon be recipients of Gordon Brown’s means-tested benefits. What a damning indictment of a government which promised radically to reform and reduce the welfare state. Mr Brown has no long-term strategy for reducing dependency and the size and the scope of the welfare state.

This Government plans to increase government spending by 3.7% a year over the next three years, when the trend rate of growth of the economy assumed for the public finances is only 2.25%. The Chancellor’s path for public spending has been criticised by not just the IMF, but even by the EU. A high spend economy is not a high performance economy. His plans to grow the size of the government will crowd out private capital. Other countries are promoting real fiscal discipline to allow space for the private sector to flourish.

Taken together, these misguided policies are already having a negative impact. Even in the relatively benign economic conditions of recent years, the UK is losing ground under Labour.

Since 1997, our economy has grown at a slower rate than that of the US or euroland. Productivity growth has slowed to just 1.4 per cent a year over the last four years. It grew, on average, 50 per cent more quickly during the previous five. Our share of world exports has fallen from 5.1 per cent in 1997 to 4.5 per cent in 2000 and manufacturing employment has fallen by over 350,000. Indeed, our overall level of unemployment, a source of great self-satisfaction for the government is in fact worse than 14 other members of the OECD. And our position in the World Competitiveness League has fallen from 4th to 9th under Labour.

However, the benign economic conditions of the global economy of recent years are changing. We all hope the economic uncertainty which has infected certain parts of the world does not spread to Britain. But if the global slowdown does have an impact on growth in Britain, and if we still had a Labour Government, the inherent weaknesses of Gordon Brown’s economic approach would be exacerbated.

High taxes and regulations that are proving an impediment to growth now would have an even greater impact in those circumstances, when competition and the search for markets would be that much more intense. Government spending would be rising quicker than growth, (and indeed even quicker than currently planned because of the need for higher benefit spending when the economy slows). The economy – particularly the private sector – would need a boost. But Gordon Brown would be prevented from offering the tax cuts that could help to ease the problem because he’s committed to a path for government spending that outstrips trend growth.

Labour would be under pressure to raise taxes faster than they had planned. The only alternative to that would be for Labour’s spending plans themselves to be ripped up and cut back. That would be an another ignominious defeat for the Chancellor and would lead to turmoil in the public services.

Rather than plotting a course for stability, Gordon Brown is plotting an imprudent path in an uncertain world. This Labour Chancellor has no meaningful fiscal disciplines. The Treasury’s rules are so weak they offer no effective checks and balances on Gordon Brown’s old-style, socialist tax and spend instincts.

In the event of a UK slowdown and second Labour term the fiscal rules that the Chancellor talks about so much would be shown to be a sham, as they offer absolutely no constraint on the amount that a Labour Government can tax and spend. The Chancellor could meet his bogus rules even if current public spending rose to 50 or 60 per cent of GDP, so long as taxes rose equally rapidly to cover the gap.

We need a new approach if we are to keep Britain competitive. We need a better policy mix that will serve us in good times as well as bad. That approach needs to be based on discipline at the macroeconomic level, and freeing businesses from state interference.

It means, keeping our own currency so that Britain can retain the flexibility of having its own an autonomous monetary policy suited to domestic conditions, like the United States.

It means making room for tax cuts by restricting the growth of government spending to within the trend rate of growth of the economy and reforming the role of the state.

It means cutting the burden of regulation on business year-on-year by setting regulatory budgets which departments have to cut.

And it means increasing the incentives to work harder and get on, by floating people free of Labour’s means-tested benefits.

In short, it means having an optimistic, outward-looking vision for a low taxed and lightly regulated Britain that can compete against the best economies in the world in the 21st Century.

William Hague – 2001 Speech at Welsh Conference

Below is the text of the speech made by William Hague, the then Leader of the Conservative Party, in Cardiff on 14 May 2001.

It is always a pleasure for me to be back in Wales. Wales gave me some of the happiest years of my parliamentary career – although, of course, that’s not all I took away from my time here.

And it is a great privilege to back among so many friends in the Welsh Conservative Party. I know that at this Election Welsh Conservatives are thirsting for the fight and are fighting to win.

We can win because of the leadership of Nick Bourne and his brilliant team in the National Assembly, Nigel Evans at Westminster and Jonathan Evans speaking up for Wales in the European Parliament.

We can win because of the hard work and dedication of Conservative Councillors across Wales.

We can win because of all of you in the Welsh Conservative Party have never wavered in your commitment to the Conservative cause and your determination to see the end of this miserable Labour Government.

And that is what all of us are going to do – ensure that Tony Blair is given his marching orders from No 10, put Welsh Conservatives back in Westminster and the Conservative Party back into Government.

To come back to Wales is to find myself again among real people: not the politically correct commentators and radical lawyers Tony Blair has in mind when he talks about “the people”. But real men and women leading real lives.

People who are more interested in how much they are paying for petrol than in how much Cardiff council is paying its leader. People who are more concerned about their child’s GCSE results than about what method of election should be used in the Assembly. People who are more interested in whether their daughter can walk safely at night than whether she should serve in the front line.

People who understand that you can be proud to be Welsh as well as proud to be British, and value what the nations of the United Kingdom have achieved together. People who Labour sometimes dismiss as old-fashioned because they still believe in personal responsibility and patriotism and the importance of family.

People and communities all over Wales, who are starting to wonder whether any politicians are in touch with their concerns. People not unlike those like those I grew up with in the Rother Valley.

My classmates at Wath-on-Dearne Comprehensive had fathers who worked in mines and in steelworks and on farms. Like all parents, they wanted their children to have the best possible start in life. They wanted their families to be financially independent. They wanted a secure old age. And, without ever making a fuss about it, they loved their country.

Even back then, they were considered unfashionable. The last thing the Labour Party wanted was to give them independence. Much better to keep them in the industrial working class. Take away their freedom of choice. Tell them where to live. Tell them where to send their children to school. Make them join a trade union. Don’t give them their own pension. Make them depend on the state for every rise in life.

Our party changed that. We gave people the opportunity to take back control over their own lives. And they seized that opportunity with an enthusiasm that astonished the world.

Now the children I was at school with have families of their own. Their jobs are in computer firms, in high-street banks and call centres; they’re nurses and teachers and self-employed builders. They own their own homes, and they’re saving for pensions. And the girls in my class are struggling to balance the pressures of being a good mother and holding down a good job.

Those are the people who motivate me. People who are beginning to wonder whether ministers will ever listen to them. Our party is in it for them, and others like them throughout the United Kingdom.

Let me be honest: when I was here as Welsh Secretary, I made a number of friends who told me they were voting Labour. They had a variety of motives. Some of them actually believed all that rhetoric about a new Britain. But most of them simply felt that Labour deserved a fair crack of the whip.

They weren’t expecting miracles. They wanted decent schools for their children, safe streets and the opportunity to prosper by their own effort. It wasn’t much to ask. But, four years on, they’re feeling let down and conned.

They were promised lower class sizes; but they’ve seen class sizes rise in secondary schools throughout Wales.

They were promised a cut in NHS waiting lists. But, although in-patient waiting lists have fallen in Wales by 2,000, outpatient waiting lists have risen by a staggering 57,000.

They were told that taxes wouldn’t have to go up. But they’ve been taxed for marrying, taxed for driving, taxed for wanting to own their home, taxed for trying to put a little aside each month, taxed for growing old. They’ve seen council tax soar in Wales, with Band D houses now paying £215 more than when Labour took office.

And they’re wondering – as we are all wondering – where all the money is going. You’ve paid the tax, but you’re still waiting for your operation. You’ve paid the tax, but you’re still waiting for news of your train. You’ve paid the tax, but when was the last time you saw a police patrol on your street?

Those people I met as Welsh Secretary, who were so keen to tell me that they were voting Labour, expected a Government that would be tough on crime. But they’ve seen police numbers cut while prisoners are let out of jail early.

They believed that the priority would be “education, education, education”. But they’ve seen teachers bent double under paperwork and classroom discipline undermined. They’ve class sizes increase and children sent home because of staff shortages.

And now they’re wondering whether any politician will ever listen to them. They’re beginning to think that nothing will ever improve. That taxes will only ever go in one direction. That violent crime can only get worse. That there will always be failing schools. That no one will sort out the chaos on our roads and railways. Even that the drift into a European superstate is inevitable.

Well I say that none of these things is inevitable. I’m not promising to have all the solutions. No politician can. But things can improve. There is no excuse for giving up.

I won’t give up on the families, the savers, the pensioners whose taxes are rising faster than anywhere else in the world. It doesn’t have to be this way. The only reason that our taxes are shooting up is that the Government has chosen to raise them.

Of course decent public services need to be properly funded. People don’t object to paying tax when they can see that the revenue is being well used. But they do object when the money going into the NHS is not spent on patient care, but on preparing accounting systems for the euro. They object when up to £47 million is to be spent on a new Assembly building. They object to being taxed to recruit new armies of clerks and officials and regulators and licensors and inspectors and bureaucrats to the state apparatus.

And they’re right to object; you’re right to object. None of us minds paying for roads and schools and hospitals. But do you really feel the same about paying £4 million to take on more Labour spin-doctors? Do you really want to spend £1.4 billion in Wales on scrapping the pound?

The fact is that we have become used to a level of service from the state that we would never accept in any other walk of life. We put up with poor schools and cancelled operations and a bad return on our pension contributions because we feel we have no choice. But we shouldn’t have to.

If you wanted to book a holiday in Spain next month, and went to the travel agent, and were told that your holiday would have to be in two years time and had to be in South America, you’d use a different travel agent. If your local supermarket never stocked the goods you wanted, but charged you through the nose all the same, you’d want a refund.

Well I say you should have that refund. If the Government has enough of your money left over to spend millions of pounds on advertising to tell you what a good job it’s doing, then it’s taxing you too much.

Taxes in this country are beginning to spiral out of control. It isn’t selfish to think this: it’s responsible. People know that you can’t spend more than you have. And they know that, at a time when our competitors are cutting tax, Britain can’t afford to drive away investment.

I don’t believe that things have to be this way. Other countries are reducing taxes without cutting services. For twenty years Britain has been the lowest taxed country in Europe. That has brought us more jobs, more investment, more trade and more economic success than any other country in Europe. Yet Mr Blair is throwing all this away. He is increasing taxes and regulation while the rest of the industrialised world is going in the opposite direction. He is out of touch with the British people who know they are paying too much for too little – and he is out of tune with the needs of global competition.

Future jobs and growth will come to countries which cut taxes, not those which keep on increasing them. Mr Blair can try, Canute like, to turn back the tide of those who want and need lower taxes – but he will not succeed. Tax cuts are an idea whose time has come.

Michael Portillo and I have shown how we can cut taxes by £8 billion. We have shown how we can fulfil our plans to reduce taxes.

Last Friday I challenged Tony Blair to repeat the pledge he made at the last election when he said that he had “no plans to increase tax at all”.

That was four days ago. What have we heard from the Prime Minister? A deafening silence.

What is the problem? It can’t be that he’s lacked the opportunity to repeat his promise. He could have told one of the callers on GMTV that he would not increase their taxes – after all, they told him they were paying too much already. He could have told David Frost that would not increase taxes. He could have told John Humphrys this morning that he would not increase taxes.

When it comes to tax increases, the best policy Tony Blair has been able to come up with is to keep mum.

He hopes the British people won’t notice that he has turned Trappist.

Too bad, Tony: we’ve noticed alright.

We all know why he won’t answer.

We all know that his spending plans require another round of stealth taxes to pay for them – £10 billion according to the Institute for Fiscal Studies.

That’s equivalent to increasing the price of petrol to nearly £6 a gallon, or £1.30 a litre.

We know why he won’t answer, and what’s more he knows.

He won’t answer because he can’t answer.

No wonder Tony Blair and Gordon Brown are rowing.

The Prime Minister has boxed in his Chancellor. Gordon Brown needs to raise taxes, but Tony Blair won’t let him say so.

So the compromise they’ve reached? A conspiracy of silence.

If we were in America and Tony Blair was asked a straightforward question on tax, he’d plead the Fifth Amendment. You know the one – that’s the one that protects people from incriminating themselves.

Watch out for Labour. They’re going to try the same deceit at this election that they tried at the last.

They’re going to tell you that they won’t raise the rate of income tax.

But you know that is just a piece of spin. They said that last time and then increased income tax for millions of people by abolishing tax allowances and dragging more people into higher taxes.

I repeat my challenge to the Prime Minister. Be honest with the British people. Give it to them straight. Will you increase taxes if re-elected, yes or no?

The Conservative Party has worked out the most detailed plan ever produced by an Opposition, showing exactly how we can make savings in Government spending without taking a single penny from hospitals, or schools or the police or the Armed Forces.

It’s not going to cure everything. But it will allow us to deliver tax cuts for small businesses and married couples and savers and pensioners and people with children.

And it will allow us, in our first year in office, to reduce the cost of petrol by 27p a gallon and that will be welcomed by the elderly, disabled people and millions of others for whom the car is not a luxury but a necessity.

People are not expecting the Earth. Just for the chance to live secure lives without having to rely on the state. It isn’t much to ask.

Pensioners want the dignity of independence in their old age. They’ve paid tax throughout their lives. They shouldn’t have to go on paying in retirement. That’s why the next Conservative Government will raise the state pension and, at the same time, raise pensioners’ tax allowances by £7.50 a week, which would take a million pensioners out of tax altogether.

And for those at the other end of their careers, those just starting out in the work place, I say: you should have the opportunity to build up your own pension fund without having to rely on the state.

People want to do the right thing: to put aside a little each month to provide for their retirement, or for their children or grandchildren. They’ve already been taxed for earning the money; they shouldn’t be taxed again for wanting to save it. The success of our economy depends on encouraging investment. That’s why the next Conservative Government will abolish taxes on savings and dividends.

And there’s no excuse for giving up on marriage. Married people provide stable homes for children. They should be rewarded, not penalised. That’s why the next Conservative Government will introduce a transferable allowance for married couples worth up to £1,000. And we will offer special help and training to women who take time out to look after their children, but who want to return to work when their children are older. Let’s not be afraid to say it: we believe in marriage.

There’s no excuse for giving up on our roads. John Prescott seems to think that driving is a vice. But just because he treats his two Jags as a luxury, that doesn’t mean that the rest of us can do the same. For women who don’t want to walk home from the station after dark, or for families trying to manoeuvre small children to school and back, or for small businesses needing to shift their goods, or for people who live in rural Wales, driving is a necessity.

Mr Prescott may regard petrol duty as an ethical tax. But I don’t see anything ethical about a tax on women and children and small businesses and the countryside. That’s why the next Conservative Government will cut fuel tax by 6p a litre, that’s 27 pence a gallon.

And we need to do it now. Because in Brussels today they’ve been discussing a plan to harmonise fuel prices across Europe. Stephen Byers admitted it this morning. And don’t think for a moment they’re planning to cut petrol tax in Britain to the European average. It’s a one way street. They want to lock in higher petrol taxes here and prevent them from ever being cut again. That’s why Britain’s drivers are saying to Labour and to Brussels at this election: hands off our fuel.

And there’s no excuse for giving up on the crime problem. It’s just not true to say that rising crime is inevitable. During the early 1990s, crime rates started to fall. But now we’ve seen record rises in violent crime, especially in the kinds of offence that tend to ruin lives: assaults, rapes, muggings.

When you spend too long looking at crime figures, it’s easy to lose sight of what each one of those recorded offences means in terms of human misery.

When a pensioner has her handbag snatched by a lout on a bike, it may not register as a major offence. But, for that pensioner, it can be a life-changing experience. She may never again feel comfortable walking along the street where it happened. She may never again feel safe outside her home.

When a family come back from their holiday and find that their home has been broken into and ransacked, the statistics simply notch up one more burglary among the thousands that take place every month. But that family’s home has been soiled and violated: it will never feel quite the same again.

There is nothing inevitable about this crime wave. It hasn’t just happened spontaneously. It has happened because police numbers have been cut, and because those officers who remain in the force feel blamed and demoralised. And it has happened because nearly 35,000 serious criminals have been released early. Police taken off the streets, criminals turned on the streets.

Think, for a moment, about what this means. Serious criminals – muggers, burglars, sex offenders, even attempted murderers – have been allowed home early. Over a thousand of these have breached their curfew conditions, and some have disappeared entirely. Many more have committed crimes while on special early release: more muggings and burglaries, more assaults on police officers, more rapes.

This did not need to happen. And it doesn’t need to happen. Mistaken policies can be dropped. It is possible to begin to put things right.

The next Conservative Government will stop early release. We will introduce tougher sentences for violent and sex offenders, tougher sentences for drug pushers, tougher sentences for burglars. And we will make prisoners serve their full sentences.

And, while they are in custody, we will make prisoners do a full working day: not artificial schemes, but paid employment. And we will see to it that some of their wages go to compensate the victims.

And the next Conservative Government will reverse Labour’s cuts in police numbers. It’s not just a question of attracting young men and women to serve in the police force. It’s a question of keeping them there. Police recruits join up because they want to serve their communities. They want to be out on patrol, not handcuffed to their desks. And they want to know that, if they stop and search a suspect, his word will not automatically be taken over theirs.

There is no excuse for giving up on crime. With resolve and a little imagination, with proper sentencing and with visible policing, it really is possible to turn things around. It has happened elsewhere. It happened in New York, where a properly motivated and resourced police force transformed what used to be one of the most violent cities in the world. It could happen here.

And I refuse to give up on the Welsh countryside. Labour ministers seem to have no grasp of how serious things have become in Wales. It’s not just hill-farms that are suffering. Livestock and dairy farmers in Wales have seen their income fall by 25 per cent in four years. Seventy-three farming jobs are lost each week in Wales, as families who have managed the land for generations are being forced to sell up. When I say that we are witnessing the asphyxiation of rural Wales, I am not choosing my words lightly.

The countryside doesn’t just need an injection of cash. It needs a vibrant and successful economy.

Coming on top of all the other problems, Foot and Mouth has been a disaster for the Welsh countryside. For so many farmers years of hard work has been destroyed in a matter of weeks. Rural businesses have seen their turnover collapse. And there have been animal welfare problems of a kind we never expected to see in Britain.

The priority of the next Conservative Government must be to help the countryside recover. So immediately we take office, and working with the National Assembly at every stage, we will implement our Strategy for Recovery, containing steps to stamp out Foot and Mouth once and for all, to help our struggling tourism industry and other rural businesses and firm action to prevent this terrible disease entering Britain again.

The next Conservative Government won’t just offer the Welsh countryside a one-off transfusion. We will aim to restore its long-term health. Our proposals come as a package: cuts in the business rate for rural shops, pubs and garages; support for village post offices; an end to Labour’s housing targets; more use of brownfield land for development; 6p a litre off the price of petrol; help for village schools; an extension of rural homeownership.

In the long term, if agriculture is to remain a viable industry, we will have to change the entire basis of the EU’s Common Agricultural Policy. If I sat down today and tried to come up with the most expensive, least efficient, most Byzantine farming system I could, I doubt I’d get close to the CAP. Every family in the United Kingdom pays three times over for the CAP: first, to support the production of food for which there is no market; then to pay for its storage, and occasionally its destruction; and then all over again as consumers to prop up artificially high prices.

So with all this money sloshing around, you’d expect some of it to be going to our farmers. But, because Britain is a food importing country with relatively a relatively efficient agricultural sector, we do very badly out of the subsidy system. In other words, our taxpayers and consumers are coughing up, not to support British farmers, but to subsidise their Continental competitors!

This cannot go on. Our farmers are among the most dedicated and innovative in the world. On a level playing field, they’d acquit themselves against all comers. But they cannot compete properly as long as they are confined by the current Common Agricultural Policy.

The next Conservative Government will re-negotiate the Common Agricultural Policy so that many decisions currently taken at EU level would be taken by the governments of individual member states. The voice of the Welsh Secretary will be vital in speaking up for the interests of Welsh agriculture.

Above all, there is no excuse for giving up on our schools. I was lucky as a boy: I went to a first-rate comprehensive. But there were other children in the neighbourhood who were less fortunate than I was: who went to schools where they were never stretched, where their ambition was never kindled, where their potential was slowly poured into the sand.

No parents should be forced to send their child to a failing school simply because of where they live. It was wrong then and it is unacceptable today. In a society as wealthy as ours, there should be no such thing as a sink school.

Tony Blair, with his customary attention to detail, promised to give us “education, education, education”. Well, I want to be a little more specific than that with my own aims. I want discipline, standards, choice.

Schools should be answerable to parents, not to politicians. That’s why the next Conservative Government will set our schools free: free to set their own admissions policies, free to decide their own rules, free to spend their own budgets. If our children are to realise their potential, we need to release the energy and enterprise of those who work in education. It can be done.

I’m not going to promise to set everything to rights. But I can promise that the next Conservative Government will clear its desks to focus on improving our education system. And I can promise that we will push more resources out to our schools.

We will set Welsh schools free from red tape and bureaucracy and allow the National Assembly to provide funding directly to schools. The Assembly will then work with local authorities to improve school standards across Wales.

We have calculated that if the National Assembly paid money direct to the schools themselves rather than through the LEAs, we can place an extra £540 a year at the disposal of heads and governors.

We recognise that LEAs provide additional functions other than funding. These will still be carried out by individual Local Authorities, but it will be for the National Assembly, as the body with responsibility for local government, to oversee these functions.

But under Conservative plans head teachers will be able to set their own priorities. Just think of how far even a part of that extra £540 could go when it comes to upgrading school facilities, or taking on extra staff, or offering children more opportunities for sport or drama or music.

But none of these things is possible if we give up on our national independence; if we give up on Britain. I have faith in this country and its people. We can prosper as a self-governing nation.

People often say to me: “Yes, I want to keep the pound. But it’s all inevitable isn’t it? We’re going to be dragged into the euro one way or another.”

No, it’s not inevitable. It’s up to you. You can vote Lib-Lab or Plaid, and see the pound abolished within two years. Or you can vote Conservative to keep the pound.

Labour may not have confidence in this country. They may not believe that Britain is strong enough to survive on its own. But I do. We’re the fourth largest economy in the world. We’re the fourth military power on Earth. We’re one of five members of the UN Security Council, one of the Group of Seven industrialised nations, we have unparalleled links with the United States, the Commonwealth and the rest of the English-speaking world. How much bigger do we have to be before we’re able to run our own affairs in our own interests?

Don’t let anyone tell you that the euro is inevitable.

And don’t let anyone tell you that believing in an independent Britain is anti-European or xenophobic. We are a European country. But we can never be only a European country. We are tied by our history and our geography to other continents.

Welsh people through the ages have settled across the seas. To this day, people throughout the United Kingdom have friends and relatives in North America, the Caribbean, Australia, New Zealand and the Indian sub-continent. It’s not we who are the isolationists; it’s those who want to lock our country into a European bloc.

And don’t let anyone tell you that we’re going to be dragged into a European Superstate.

The Conservative Party wants to be in Europe, not run by Europe. We want the EU to do its job, and to do it well. But there are plenty of policies that could and should be returned to the nation-states.

Look at the record of the Common Agricultural Policy, which has pushed up prices and taxes across Europe while leaving Welsh hill farms and the Welsh countryside devastated. Look at the pettifogging rules that have choked so many of our small businesses.

Labour’s policy is to take the EU institutions that have done all this, and put them in charge of our money, of our defence policy, even of our criminal justice.

Our policy is that Brussels should do less and do it better. That’s why the next Conservative Government will pass a Reserved Powers Act, to prevent EU law from overriding the will of Parliament in areas which Parliament never intended to transfer to the EU. We want our children and grandchildren to inherit the same freedoms that we inherited from our parents.

I trust our people. I am proud of this country: comfortable with its past and confident about its future. I don’t believe that we have to go along with every new Brussels initiative simply because others are doing so.

So let me make one thing clear today. If other members of the European Union want to go ahead with political integration, if they want to merge themselves into a larger union, a Conservative Britain will not be part of it. We shall cheer them from the sidelines: they will always be able to rely on our open markets, on our diplomatic support, on our military alliance.
But we will never compromise our democracy; we will never bargain with our independence.

And so to everybody who shrugs in despair at politics, who thinks that nothing can be done about higher tax and more crime and European federalism and the asylum crisis, I say: something can be done. We don’t promise miracles. But we can make a start.

We are ready to govern for all the people. For people in the countryside, who have almost given up on ministers ever understanding them. For people in our inner cities, struggling to bring up families on crime-ridden estates with failing schools. For people in towns and suburbs in Wales, and all over Britain, who are watching their green spaces disappear inexorably under concrete.

We will govern for taxpayers wanting to see some return on their taxes. For nurses and teachers and policemen who want to get on with their jobs, not be snowed under with paperwork. For people who believe that the countries of the United Kingdom have achieved more together than they would separately, and who refuse to feel ashamed about our history. We are in it for all the people.

To parents who want the best for their children, who believe that teachers who run disciplined classrooms should get our support, not end up in court: we’re in it for you.

To pensioners who have already done their bit, and who don’t understand why they are still being taxed: we’re in it for you.

To people who live with the daily reality of crime, who feel that their town centres are closed to them on a Friday night and who can’t remember when they last saw a policeman on their street: we’re in it for you.

To parents with young families, struggling to make their budgets stretch that little bit further: we’re in it for you.

To all the small businesses and self-employed people who are wasting more time than they can afford to on complying with regulations: we’re in it for you.

To people who work hard, save hard and try to be independent of the state: we’re in it for you.

And to everyone who believes in an independent Britain: we’re in it for you. Come with us, and we will give you back your country.

Charles Kennedy – 2001 Speech to the Financial Markets Association


Below is the text of the speech made by Charles Kennedy, the then Leader of the Liberal Democrats, in London on 23 January 2001.

Ladies and Gentlemen

I am delighted to be here this evening.

I’d like to begin by thanking Hugh Macdonald and Martin Ely

for inviting me to meet you all.

The former Conservative Chancellor

Nigel Lawson once famously called ACI UK

“a bunch of City scribblers”.

Diplomacy was never really his strong point.

I can assure you that I have a higher opinion of your organisation

and look forward to talking to many of you later to hear your views.

London remains the largest financial centre in the world

accounting for almost one third of global currency business.

As such issues that affect that City and those who work in it

are of great importance to politicians of all parties

and naturally to government, let me be clear from the outset.

I want the City of London and the UK financial services industry

to be the global leader. Government should do all that it can

to enable you to do this.

At home that means competitive taxes, consistent policy, and sensible regulation.

In Europe – completing the Single Market,

winning for the City of London

and getting the economy right for Euro entry.

In the world, opening up the market for financial services.

Where regulators need to be tough they should be,

with the full support of politicians.

Tough because reputation and confidence

The most important ingredient for a healthy economy,

I believe, is financial stability.

That is why the Liberal Democrats entered the last election campaign

advocating independence for the Bank of England.

We were delighted that the Government chose to adopt our policy

which has proved to be very successful.

No decision has done more to end boom and bust economics.

However, the other chief ingredient in economic stability is

exchange rate stability.

On this, the Government has failed.

Prolonged over-valuation of sterling

has done a great deal of harm

to certain sectors of the UK economy.

Which is why the Liberal Democrats

advocate membership of a successful Single Currency

at an appropriate exchange rate

subject to the consent of the British people.

Last May, my party set up a commission,

chaired by Chris Huhne MEP,

whose members included such people as

Willem Buiter of the Bank of England Monetary Policy Committee,

and a variety of other distinguished

City practitioners and economists,

to advise on those measures Britain needs to take

in order to join the Euro-zone successfully.

Their report was published in September.

Yet, almost five months later the Government

still has not taken a lead on this issue.

My Party welcomed the step forward

that was taken in financial regulation

in the City in the last few years.

We have a high personal regard for Howard Davies

and believe the concept of the FSA is the right one.

Whilst regulation must never be over-bearing

we have always believed that the FSA

must take full account of the need

for proper consumer protection

in the job that they do.

In this respect,

regulators need

to be prepared, on occasion, to be tough to ensure that

And that means there should be no hiding place

for those who have mis-sold pensions,

failed to deliver on endowment mortgages

or closed rural bank branches.

Economic efficiency and social justice can, and must,

go hand in hand.

Before moving on to the main theme of my speech

I want to take a moment to

make some points on two specific regulatory issues

of which you will no doubt be aware

and which are of great importance to financial service institutions

as well as to politicians both as public policy makers

and as representatives of our constituents’ interests.

The first is the recent AXA deal on disposing

of its ‘orphan assets’,

And the second is the plight of Equitable Life

whose many policyholders

may suffer some heavy losses

as a result of the company’s difficulties.

Both of these issues are linked,

in my mind,

by the role of the FSA in regulating each company.

And they have implications

for the job that the FSA is doing more widely.

The recent controversy over the AXA deal on ‘orphan assets’

and particularly the role of the FSA

in giving it the green light to that deal

is a source of great concern to me and has been much commented on.

We have great sympathy with the Consumer Association

in the action that they took on behalf of consumers.

Government ministers

seemed to indicate a few years ago

that ‘orphan assets’ belonged to policyholders

in a ratio of 9 to 1.

Yet now, the AXA case would now seem to imply

that this principle has been undermined.

Previously I had understood

that ‘orphan assets’ were to be allocated

according to the ‘90% rule’

whereby nine tenths of the value of those assets

is given over to policyholders.

In the AXA case, the figure is much closer to a mere one-third.

This case is particularly important not only because it affects

the 660,000 with-profits policy holders

who are disputing the £1.68 billion worth of AXA ‘orphan assets’

but also because it has implications for those

with a potential claim on the £20 – 30 billion worth

of unallocated ‘orphan assets’ in other insurance companies.

Many thousands of people

throughout the country could be affected.

How to best dispose of ‘orphan assets’

is a source of some debate I acknowledge,

but I am not at all convinced that the regulator should have agreed

to in effect transfer well- over £1 billion

from AXA policyholders to AXA shareholders.

And I’m not at all convinced that the regulator should have agreed

to a ballot where AXA policyholders

were asked to agree a deal on the basis of

a ‘take it or leave it’ cash offer.

in which only those who voted in favour of that deal

would actually be entitled to the cash.

This is rather like Gordon Brown giving pension increases

only to those pensioners who voted Labour.

Ballots – whether of AXA policyholders, trade unionists or Florida electors – must not be open to question.but at first sight the outcome of the AXA case would seem

to contradict the Government’s intentions.

Moreover, the FSA’s stance throws doubt

on its willingness to defend the consumer interest.

This is not the only issue

in which the role of the FSA has been controversial.

The Equitable Life case is a cause of enormous concern too.

I appreciate that Equitable Life is not insolvent,

but it is in severe financial difficulties.

Many policyholders could suffer losses,

or returns below reasonable expectations.

There has clearly been a serious failure by management,

by the FSA, and quite possibly by the DTI at an earlier stage

which has allowed the situation to develop

into the crisis we see now.

Last year, Vincent Cable MP,

the Liberal Democrat Shadow Trade and Industry Secretary,

called on the Chancellor of the Exchequer

to instigate an immediate independent assessment

into possible regulatory failure by the FSA in this case

which could lead to compensation for any investors

who have been misled.

he Government has acknowledged

that the FSA has a case to answer

but responded to this by announcing

that the FSA itself would be charged with investigating

its own performance as regulator.

This is simply not good enough.

In both the AXA ‘orphan assets’ decision,

and the Equitable Life case,

the performance of the FSA as regulator

would seem to have been inadequate at best.

Many people would call it incompetent

The FSA was set up

to be champion of the consumers interests –

it should be just that.

London cannot afford a ‘paper tiger’.

It is time for the Government to

force the FSA to be more rigorous

and to take its share of responsibility

for any mistakes that have been made.

Investors and the wider public

must have confidence that it is doing its job on their behalf.

The City of London must not be over-regulated,

but must be regulated in a way also needs to must be regulated

in a proper way

so that protects and enhances London’s

excellent reputation

around the globe is maintained.

The reputation of politicians on the other hand

is probably beyond redemption.

You may be surprised to hear someone like me say that,

but I am genuinely concerned that

the public’s perception of politics

and the political class

is at an all time low.

You may have seen some press speculation recently

about the probable date of the next General Election.

Indeed, the media have

reported that an unofficial election campaign

by the three main parties is already underway.

Given that the likely date of the General Election

is the 3rd of May

I am truly depressed that the electoral “Phoney War”

seems to have begun

almost four months before anyone

is likely to walk into a polling booth.

And I am particularly angry because

this is exactly the kind of behaviour

that is putting more and more people off voting

and off participating in the electoral process.

At the last round of local elections in May 2000

voter turn-out in some parts of the country

was as low as ten per cent.

That is an horrendous figure to anyone

who cares about inclusive politics.

I am deeply, deeply worried by it.

And the other two parties are already engaging

in the usual pre-election Dutch auction

over tax and spending –

pretending that you can magically tax people

less and less

and yet spend more and more

on the things that people care about.

The public know that you don’t get

something for nothing.

This kind of debate

with both other parties striving

to reach the lowest common denominator

does a great deal to turn the public off politics

and create cynicism about the promises of politicians.

I fully intend that the Liberal Democrats will enter

into the forthcoming election battle

as the only major political party

who are prepared to be honest with people

about the cost of investing properly

in our public services:

in schools, in hospitals, in pensions and in the police.

This debate should not be characterised simply as “tax and spend”.

All Governments raise taxes

in order to spend the revenue they bring.

I want the debate to focus on

what we as a nation see as our priorities

for investing in public services

based on how we as a nation are prepared to fund them.

I believe that the British people

do want to see investment in public services in this country.

A country in which the NHS

provides decent care for all, free at the point of delivery.

A country in which schools are properly funded

and teachers properly valued.

A country in which older people share fairly in increasing prosperity.

And a country in which all in society feel free from the fear of crime.

And that investment is funded by all of us

through the tax system.

That is why I will enter the forthcoming election

promising honesty in taxation.

Telling people exactly how we would invest their money

in the services which they use,

and from which they may benefit.

In an age of political cynicism

one of the ways that these and many other policies

could best be discussed

in front of as wide an audience as possible

would have been through a debate

between the three main UK party leaders

during the election campaign itself.

As you may know, the BBC and ITV

approached Tony Blair, William Hague and myself

with a set of non-negotiable proposals

for two debates to take place between us during the

final two weeks of the General Election campaign.

I have long believed that in a television age such debates

would be an important addition to the democratic process

allowing the public to see the Party Leaders debating

outside of the juvenile environment of Prime Minister’s Question Time.

Because of this I have agreed to the broadcasters’ proposals for a debate.

William Hague has agreed also.

Unfortunately, as you may have seen in the papers,

Tony Blair has refused to take part,

arguing that the British people are not electing a President

but rather individual MPs.

This is true, and I do not want British electoral campaigns

or British politics

to become presidential in nature.

Well, I accept it is always good to see a sinner repenting.

But only a Labour spin doctor could argue

that the farce of Prime Ministers Questions

is a substitute for a serious leaders’ debate.

Mind you self-evidently debates are dangerous.

So dangerous that they have had them in the United States since 1960.

Canada since 1962.

Germany since 1969.

Holland since 1977.

Australia and New Zealand since 1984.

And South Africa since 1994.


No, Tony it’s called democracy.

But I do believe that Leader’s debates

would have done a great deal to re-engage

and hopefully re-enthuse the public

ahead of election day.

And now that these debates will not take place

I think Tony Blair must be prepared

to accept much of the blame if

voter turn-out is down again at this election.

By shying-away from debating with William Hague and myself

he is doing the country and the electoral process

a great disservice.

Nevertheless, it would be unfortunate if

arguments over the Leader’s debates

to detract from the issues that will be

crucial in the forthcoming election campaign.

Because there are real reasons

why the next General Election

should concentrate on issues of greater importance

to the British people

and to the future direction of our country.

The Liberal Democrats will enter that election promising

further targeted investment in our public services.

Honesty and openness in taxation.

More decentralisation away from Westminster and Whitehall

to the nations and regions of Britain.

A sensible relationship with our European partners

with whom we, as a nation, do so much of our trade –

not least in the financial services sector.

For the Liberal Democrats 2000 was a very successful year.

In May we recorded 28% of the vote in the local elections,

the highest share of the vote

we have ever received in a national election

which enabled us to capture

previous Labour strongholds like Oldham.

And on the same night we captured

what had previously been the safe Tory parliamentary seat of Romsey

in a Westminster by-election.

I want to translate those results

into further success at the polls this year.

There is every chance for my party to do so.

Liberal Democrats are already in national government

in Scotland and Wales.

We are already in local government in town halls

up and down the United Kingdom.

We will be fighting this election hard.

I intend for my Party to take more votes and more seats

from both Labour and the Conservatives.

No-one should expect us to do any other.

Charles Kennedy – 2001 Speech to the Social Market Foundation


Below is the text of the speech made by Charles Kennedy, the then Leader of the Liberal Democrats, on 29 January 2001.


What’s it’s all about?

Does it matter?

Why, above all, is a party leader here this evening,

talking about an abstract political concept,

just three or four months before an election.

That could be a risky strategy,

when all the pollsters and pundits tell us,

that people are bored by politics,

and that the only chance we have of getting any message across,

is to talk about schools, hospitals and pensions,

in only the most basic terms.

Well, one of the arguments I shall make this evening,

is that schools, hospitals and pensions are issues of liberty,

and that progressive politicians have all too often lost sight of that basic case.

More of that later

But I want to start off focusing,

on one of the traditional liberty issues:

civil liberties.

When I look at the current government,

and its record on civil liberties,

I find it very difficult to attach the label progresssive to it.

Just look at Labour’s record.

Preventive detention of people with ‘severe personality disorders’.

Snooping on private e-mails.

Removing benefits from offenders,

if they don’t meet all the requirements of community service.

Mandatory drug testing of those arrested.

Denying bail to drug addicts.

Restricting the right to trial by jury.

Failing to tackle drugs afresh.

Labour’s priorities veer too much towards punitive populism.

Neither treating the causes of crime,

nor safeguarding the rights of the individual.

There is, I sometimes think, a judgement made by Labour politicians,

that they have to out-Tory the Tories on crime.

That somehow, knee-jerk reactions are the best.

policies like ending jury trials.

Or blanket curfews for kids.

That’s just a hammer to crack a nut,

And the kind of policy you would expect,

from a Conservative Home Secretary,

not an allegedly progressive one.

It’s not just the policies of the government that worry me.

It’s also the tone.

The current Home Secretary likes to lash out

at so-called ‘woolly Hampstead liberals’,

joining William Hague’s refrain

that liberals are the cause of most of Britain’s ills.

I don’t just blame Jack Straw.

I do think that Labour’s obsession with spin,

is partly to blame.

On that subject, I like the quote from the 1997 election.

It came from a Labour Party press officer.

” Later today Tony Blair will be spontaneous. Tomorrow he will be passionate.”

But the problem doesn’t just lie in Number Ten.

The New Statesman said a while back,

in an interview with David Blunkett,

that if he became Home Secretary,

he’d make Jack Straw look like a woolly liberal.

Well, if Jack Straw is a liberal,

then I’m Ann Widdecombe.

There are too many signs of the centralising, bossy and collectivist tendency

that was so much at the heart of Old Labour.

Unfortunately, it seems also be part of New Labour.

Little change there,

as far as I can see

in the basic culture of the party.

It’s a travesty of what this Labour government could have been.

A concern for liberty should not be alien to the Labour Party.

It was deeply rooted in the ethical socialism of the early part of the last century.

The early speeches of Ramsay MacDonald spoke vividly of individual freedom.

And Roy Jenkins’ record as a liberalising Home Secretary,

was an impressive one.

But the differences now,

embodied in the figures of ministers like Jack Straw,

are all too apparent.

And that’s why all this recent talk,

of electoral pacts between ourselves and Labour,

is so preposterous.

For four reasons.

First, we are fighting to defend seats against Labour

and to win some more from them.

In my own seat, Labour was in second place in 1997,

so I need no lesson in how to win against Labour.

Second, I don’t just want to win more seats at this election.

Wherever we fight, I want to win more votes for the Liberal Democrats,

so that we can get into second place where we are third,

and so that in the election after next, we can win even more seats.

Third, across the country,

we will be fighting Labour hard on civil liberties.

Highlighting the government’s illiberal policies on asylum and law and order.

It is our territory, and we are deeply disappointed with Labour’s record.

And finally,

I don’t believe that party leaders should dictate to the voters,

by restricting their choice at election time.

Only Labour, with its centralising approach,

could believe that is the right way,

or even that it’s possible.

But it’s not the Liberal Democrat way.

And it’s a basic issue of political liberty

that I think all progressives should feel strongly about.

So at this election,

there will be no pacts, no deals,

where the Liberal Democrats and Labour are concerned.

Wherever we stand,

and that will be every seat in England, Scotland and Wales,

our candidates will be fighting for every single vote.

Anything else would be betraying the cause we believe in,

and which Labour does not.

I’ve talked about civil liberties.

And I want to talk now about wider issues of liberty.

The ones that aren’t always seen as liberty issues.

Liberty is of course about government not telling you how to live your life.

But it should also mean social justice.

Nearly a hundred years ago,

The Liberal philosopher Hobhouse said,

‘the struggle for liberty … is the struggle for equality’.

He was right.

If you live in a high rise flat,

bringing up a child on your own,

or struggling on a pension,

liberty isn’t about government making you buy healthcare or education.

If you live in those conditions, liberty is about social justice.


Decent public services.

Decent welfare support when times are hard.

A first class education system.

Whatever your income, whatever your background.

That means a key role for politics,

and a role for government.

And it is a great contrast to the Hague approach.

The Conservatives tend to equate liberty with rampant market forces.

They think that government,

especially at a European level,

is public enemy number one.

But I take the view

that liberty does not mean ‘minimum government’ for the sake of it.

It seems to me preposterous to assert that people are more free,

when government does less.

If government did nothing to provide decent health and education services,

then many people in Britain would be manifestly less free,

because they would not be able to provide these services for themselves.

For me, social justice,

protected and enhanced by government,

equals more liberty.

If progressives recognised this openly,

that would represent a major shift in progressive thought.

Traditionally, we have been hung up on the conflicts between liberty and equality,

seeing them as somehow contradictory.

But I don’t think we should see them as contradictory.

Instead, we should recognise them to be two sides of the same coin.

For guidance on how to do that, we can turn to Isaiah Berlin.

Isaiah Berlin was the first person to argue that there were actually two sorts of liberty.

Negative liberty and positive liberty.

Negative liberty, he said,

means wanting to curb authority,

leaving individuals alone to do what they want,

providing that their actions do not restrict the freedom of others.

Positive liberty was different.

It meant using political power to emancipate.

It meant groups, or the state, judging what was best for individuals.

Berlin did not oppose positive liberty entirely.

In fact, as Michael Ignatieff’s biography points out,

Berlin was, in politics, a New Deal liberal.

He was neither a conservative,

nor a laissez-faire individualist.

He accepted that poverty and ignorance were not the ideal conditions for liberty.

But Berlin did urge us to recognise the contradictions between liberties.

The conflict between negative liberty and positive liberty.

He would want us to recognise

that although we may tax somebody to create opportunities,

we may still be restricting the liberty of the taxed.

That is the heart of the conflict between positive and negative liberty.

I think this is a conflict that can help us.

Although not quite in the way Isaiah Berlin would have liked.

What we have to accept,

is that although there are conflicts between negative and positive liberty,

they are still both forms of liberty.

Both are about promoting individual freedom,

giving everybody the chance to make the most of their life.

So I think that it is now time to recast the liberty-equality debate,

into a simple liberty-liberty debate.

We have to recognise that we are not,

when we speak of investment in education,

talking about creating equality.

We are talking about creating liberty.

Yes, it is positive liberty, but it is liberty nevertheless,

and that can, I think, make it easier to pursue an agenda

which incorporates both traditional liberty issues,

and traditional equality issues.

That is where New Labour has, I believe, failed.

Although we hear a lot less about the Third Way than we used to,

it still lies at the heart of the Labour approach.

The logic goes something like this:

do something left-wing one day, and right-wing another,

or talk right and act left.

and all will be fine

You will build a Big Tent,

that everyone can enter.

But all you end up doing,

is building a Big Dome,

which has no Big Idea,

and very few people want to enter a Big Dome.

This is where, in my view, the Liberal Democrats are succeeding.

We published our general approach to this last summer,

in our pre-manifesto, Freedom in a Liberal Society.

It states quite clearly our view that there can be a modern progressive politics,

that takes traditional equality issues,

and recasts them into liberty issues.

It takes the issue of the liberty,

and places it right at the forefront of the message we will take to the country.

By doing that, I hope that we can make liberty not only the challenge for progressives, but the challenge for the country as a whole.

Alan Milburn – 2001 Speech to the CNO Conference

Below is the text of the speech made by Alan Milburn, the then Secretary of State for Health, to the CNO Conference in November 2001.

It is a great pleasure to be here today with people who are leading the process of reform and improvement in the NHS.

Wherever I go in the NHS it is no coincidence that where reform is taking hold nurses are often in the lead. NHS Direct – led by nurses. NHS walk in centres – led by nurses. Nurses, midwives and health visitors – leading reform in primary care, hospital services, rehabilitation, maternity services. Nurses were modernising NHS services before it became fashionable.

That’s true because nursing values are NHS values. Caring. Compassionate. Professional. Dedicated. The needs of the patient at the core of all you do. Everything we do has to preserve and promote these values. Our programme of reform and the nursing profession’s guiding values are as one – they are about redesigning the NHS around the needs of patients. That is what reform must mean – tearing down the barriers between health and social care, removing the demarcations between NHS staff, ending the old ways of doing things that stand in the way of more patients getting quicker, higher quality treatment.

Reform and innovation is taking hold out there. It is important that we harness it and that we evaluate it. I know there have been concerns about the level of investment going into nursing research about what works best for patients and what does not. So it is a pleasure to be able to tell you at the outset that I have decided to spend over £6 million over five years on a new programme of research to support the delivery of high quality evidence-based nursing and midwifery care.

Much of what I want to say today is about the greater role that I believe nurses can play in delivering improved services for patients. But I want to try to locate the contribution that I believe nurses can make – and are making – in the context of the wider reform programme taking place today in the NHS.

I want to start by thanking you for what you do, day-in, day-out, on behalf of patients. I know nurses – whether it’s in the community or in hospitals – are working under very real pressure. You are on the front line of many of the major challenges which face our country today – addressing the problems of poverty and deprivation, a growing elderly population, growing public expectations too.

Meeting these challenges must sometimes seem like a Herculean task. Sometimes there is scant thanks for what you do. And yet just a few months ago when people faced the choice in this country between short term tax cuts and long term investment in public services, the country backed public services and they backed the people working in public services. I think we should all take heart from that.

People have learned a harsh lesson over the last 10 – 20 years. Today people know a fair society, where everyone in our communities and not just some get a fair chance, can only be built on the sure foundations of a strong economy and strong public services.

We all know today we are a long way from having public services to match Britain’s position as the fourth largest economy in the world. We know too that the public are deeply impatient for change. Some commentators, some politicians even, say public services can never deliver, that private provision is the only answer.

I say that on grounds of efficiency and equity that view is wrong.

The NHS is the fairest way of providing health care to our people. It is based on the right principles – of care being available according to the scale of your need not the size of your wallet. But I say with equal firmness that failure to deliver reform in the NHS will prove the cynics and the doubters right. Reform has to deliver NHS services that are more responsiveness to the people who use them.

People grow up today in a consumer society. Services – whether they are private or public – succeed or fail according to their ability to respond to modern expectations. People today exercise more choices in their lives than at any point in history. Many can afford to walk away from public services which fail to command their confidence. People will no longer tolerate second rate services, dirty wards, waits of 18 months for an operation or 18 hours on a trolley. That’s why there is such a huge effort going on to redesign services from the patients point of view. To get waiting times down, make services more flexible and more convenient for the people who use them. To provide easier access, round the clock.

These big changes require big reforms:

To put in place for the first time national standards and independent inspection to monitor them.

To provides incentives to reward good performance and help to correct poor performance.

To devolve power to frontline staff in frontline services to encourage diversity and local creativity.

To change how services are organised and how staff are employed so that the needs of the patient always come first.

To give patients more choice including through greater co-operation between the public and the private sectors.

These reforms aren’t easy. Reform is high risk. In the NHS today there is a huge programme of change taking place. There is a lot of weariness and I know there’s quite a lot of wariness. But I believe passionately that the risks of reforming are far less than the risks of standing still.

The stakes are high for the health service. The debate on the NHS has moved on. For years it was all about the need for more investment, since for decades the NHS had suffered under-investment. Today we are putting that right. And because sustained investment will continue throughout this Parliament the debate on the NHS is now very different from what it was just a few years ago.

The debate today is about whether even with this enhanced level of resources the way we organise and fund health care in this country can ever deliver a modern patient-focussed service.

I believe there are good grounds for optimism. For a start the investment is going in with the NHS today the fastest growing health care system of any major country in Europe.

People – staff as well as patients – sometimes ask where the money is being spent. Aside from on staff – including the thousands of new staff the NHS is employing today – it is going on providing better services to patients. For example, waiting times of over twelve months for a hospital operation have fallen by 13% in just one year. Cancer patients are being seen by a hospital specialist within two weeks when they used to have to wait months. There are 3,000 more heart operations, over 150 more chest pain clinics, 17% more cardiologists. Prescribing cholesterol-lowering drugs is up by over one third. We are spending over £250 million on new drugs for conditions such as cancer, heart disease, dementia and arthritis. Free nursing care has started. 7 million callers a year are being helped by NHS Direct nurses. 40 nurse-led Walk in Centres are now open. 1,000 GP surgeries are being improved. Thousands of new intermediate care beds and places have been established. The biggest hospital building programme in NHS history is underway. This year for the first time in thirty years there are more beds in hospitals. The programme we outlined in the NHS Plan is on course to be delivered.

I know there is a long way to go. There are very real problems to set alongside the real progress being made. Patients wait far too long for treatment. Staff shortages. Dilapidated buildings. Outdated equipment. Decades of neglect have taken their toll on the NHS and indeed on people work in the NHS. Only a fool believes that decades of neglect can be reversed in a few years of investment. The NHS Plan is not for one year or two years: it is for ten years.

So it really is time that we had a bit of balance in the debate about the NHS. Not only is the glass half full and not half empty – it is being topped up. No one should fall for the fallacy that unless we solve every problem in the NHS no problem is being solved at all. We know in these next few years we must deliver improvements and by working together we will deliver.

Delivery crucially depends on one million NHS staff. Without you it simply will not happen.

That is why we need more nurses at the frontline – in primary and community services as much as in hospital services. We’ve made a start. Nursing vacancies – while still too high – are falling. There are 17,000 more nurses working in the NHS today than just four years ago. And there are 20,000 more to come.

The cuts in nurse training that took place in the 1990s have now been reversed. Indeed, there has been a 40% increase in nurse and midwifery university places. Applications for nursing degrees are up by over 80%. And I can report today that the latest figures show that the number of nurses who left the NHS but who have now returned is well over 9,000.

We’ve turned the corner on nurse recruitment. But we can’t have people coming in through the front door and leaving by the back door. Retaining nursing staff must now be the priority.

A fairer deal on pay will play its part. We do need a fairer pay system for rewarding nurses and other staff for the enormous contribution they make to patient care. Negotiations are going well and I am determined to press ahead with final negotiations on all elements of the new pay system. The aim will be to complete this work as early as possible next year so that a final agreement can be reached as soon as information on future NHS resources are available. Following consultation by the NHS trade unions, this will enable us to begin the process of implementation during 2002/3.

Providing we can reach agreement, many nurses will be significant gainers from the new pay system we envisage. In the meantime we will continue to target extra help to aid both recruitment and retention including in those parts of the country where the cost of living is highest.

More pay alone will not do the trick. The truth is we will not be able to get more nurses at the NHS frontline unless we offer more support at the frontline. By offering nurses more flexible employment, as every NHS employer will have to do within the next few years. By using the £100 million we will save as health authorities and regional offices are abolished to invest in extra childcare to help nurses balance their family and their working lives.

As an organisation – throughout the organisation – the NHS must now focus on removing those barriers that stand in the way of nursing staff being able to use all of their skills to improve services for patients.

Our reform programme for the NHS has at its core an absolute determination to harness the commitment and know-how of staff to improve care for patients. Where nursing staff have been given their heads they have delivered far-reaching change. I see that wherever I go in the NHS.

Matrons empowered to get the fundamentals of care right for patients. Hundreds of nurse consultants now in post. Reforms which have used nursing skills to make same day tests and diagnosis the norm and not the exception. Reforms which have cut waiting times for dermatology treatment from months to days by putting nurse consultants and GPs in charge of providing the service. Reforms which have used the skills of nurses to speed up treatment for cancer patients. Reforms which have allowed nurses in accident and emergency departments to assess patients and so cut waiting times for treatment.

These reforms – alongside the investment in more nurses, more doctors, more skilled professionals – are about using skills to best effect, with care delivered by teams and with flexibility around the needs of patients. These reforms are breaking through the old demarcations. They are liberating the skills of nurses to transform services for patients. What is happening in some places now needs to happen everywhere.

The people at this conference today are central to this reform programme. Your job is to empower nurses to deliver patient-centred care. You already have some the authority to do that. Now I want top give you more authority still.

A year ago the Chief Nursing Officer published her ‘Ten Key Roles for Nurses’ in the NHS Plan. She set out the functions that appropriately qualified nurses should be allowed to perform to improve care for patients. In the best places nurses have been allowed to take on these new roles. In too many places they have been stopped from doing so.

In my view it is just absurd that in some hospitals nurses can order x-rays while in others they can’t. Or that in one hospital nurses can discharge patients but in a neighbouring one they can not. Limiting nurses roles and holding back nurses talents not only makes nurses and doctors the losers. The patient loses out.

For too long there has been a vicious cycle where the NHS has not been able to perform to its full potential because it has failed to support staff to perform to their full potential.

Today I can tell you how we intend to change this situation so that nurses everywhere are able to use their skills to the full. The key will be the modern matron. Matrons will champion the interests of the patient within the hospital so matrons must also champion greater power for nurses within the hospital.

That’s why I will be asking matrons in every hospital to report annually on how the 10 key roles for nurses are being implemented. I am going to ask them to produce an annual report which will go to their Chief Executives, who have the ability to remove organisational blocks to greater nursing influence. It will go to the Chief Nursing Officer, who will be able to remedy legal and professional blocks as well as identify variations between different hospitals. And most importantly, it will go to their hospitals new Patients’ Forum so that patients can see whether the necessary reforms have taken hold.

This is about allowing nurses to break through the glass ceiling that has for too long held them back. It is about unlocking the talents of nurses to improve care for patients. And there is one further development that I can announce today to help make that happen.

I am convinced we need more clinicians in key leadership roles throughout the health service. That is why I was disappointed to see the results of the survey of Nurse Directors we commissioned through the Modernisation Agency. Only around half of Nurse Directors who apply for Chief Executive posts get an interview.

The majority apply only once because they are put off by the selection procedure which, ironically, makes them feel that they are unsuitable for a Chief Executive post because they are a nurse. Often they play down their nursing role and clinical expertise, yet it is precisely that clinical insight and understanding of patient care that is the experience we ought to value most in our top people. It is precisely because nurses are closest to the patient in the NHS that we need nurses closest to the power in the NHS. Nurses need to be in positions of leadership right across the NHS. There must be no glass ceilings for nurses.

We have already made funding available to provide leadership development programmes for over 30,000 frontline nursing staff. I can announce today a new programme to develop nurses as potential Chief Executives. The programme will be specifically designed for nursing, medical and allied health professionals to put them on an equal footing to compete for Chief Executive posts. Next year it will provide up to 100 places for senior clinical leaders.

All of this is about one thing: to unleash the tide of innovation that exists amongst staff in every surgery and in every hospital.

In our first term, the Government established a clear framework of national standards and policies to help us address the postcode prescribing and postcode performance which existed across the NHS. With these in place from our first term this second term is all about shifting the centre of gravity to staff at the NHS frontline.

The NHS is a high trust organisation. It works on the basis of trust between patient and professional. In the way it is organised the NHS now needs to enshrine that trust. It needs to give more control to the NHS frontline. I don’t treat patients. I don’t work in the GP surgery or the local NHS hospital. You do. The NHS can not be run from Whitehall. Just as schools now have greater control so local health services must now be given greater control too.

Last Friday, we published the NHS Reform Bill to ensure that by 2004 the GPs and nurses, patients and local communities who run primary care trusts will control three quarters of the total NHS budget.

By then two-thirds of existing health authorities will have been abolished. The NHS regional offices will have been abolished too. Power will have been devolved to frontline NHS services. Cash for local health services will be allocated directly to local primary care trusts so that they can decide how to commission services for the local communities they serve. I have heard from too many people too often in the NHS that resources have not been getting through to the frontline. The NHS Reform Bill will mean resources going directly to the NHS frontline.

The government’s reform programme has to breakdown the monolithic structures of the NHS in favour of a more decentralised pluralist and responsive health service. A modern health service can not be run like an old style centralised bureaucracy but should instead devolve power and resources to frontline services and frontline staff. The advent of Primary Care Trusts – in which nurses must play a leading role – is the biggest devolution of power in the history of the NHS.

I want to see a new culture of public sector enterprise in the NHS to rival the spirit of private sector enterprise which developed during the last few decades in our country. That requires more discretion over how local budgets are spent. It requires greater freedoms and more rewards for organisations which succeed. It requires greater help and more support – rather than blame – for those which do not. And it relies on you using your authority to innovate and develop new ways of delivering services to patients.

As standards and performance improve so greater autonomy will take hold. Good hospitals will get extra resources to help turn round persistently failing hospitals. And devolution to NHS organisations will be matched by devolution within NHS organisations. More qualified nurses should have the power to prescribe. Matrons will have the power to fine cleaning contractors that fail to keep wards cleans. In hospitals ward sisters will have control over ward budgets. In the community health visitors will have control over community budgets.

We need to go further still. Many hospitals already involve ward sisters and charge nurses in managing their ward staffing budgets. I can announce today that the Modernisation Agency, will over the next 12 months, lead a management programme to support the devolution of staffing budgets to those ward sisters and charge nurses in England’s hospitals who do not yet have that control.

An Audit Commission report on ward staffing, being published today estimates a typical ward budget for a cardiology ward at £560,000 a year. Within 12 months I hope all ward sisters and charge nurses will be in control of ward staffing budgets.

Ward sisters and charge nurses are best placed to know the day to day needs of patients and the hour by hour demands on staff. It is because they understand that they should be in control. They should be able to decide the mix of grades, the mix of skills, the mix of jobs they need on the ward. Patients on a ward, particularly the elderly and most vulnerable, need caring skills alongside clinical skills. Some feel that over the last few decades these caring skills have got lost. I believe it is time to re-emphasise them. That is why we have placed such a strong emphasis on cleaning up the wards, improving the food and introducing new jobs such as ward housekeepers to make sure that patients day to day needs are being met. Meeting patients’ needs will be enhanced by allowing ward sisters to decide the number and mix of nurses, care assistants and ward housekeepers. It will be the job of matrons to support ward sisters and charge nurses to discharge these functions.

After almost half a century of central control Whitehall must devolve NHS resources to the NHS frontline. To decentralise decisions to staff at the NHS frontline. To deliver better care for patients at the NHS frontline.

This is the programme of reform we are embarked upon.

It is a programme where local communities will have greater say over the local health service.

Where the health service is more diverse. Where services are more responsive to patients and where patients have greater choice over services.

Where public and private providers work together to deliver the core NHS principle – care that is free, according to need not ability to pay.

It is a programme where the power of nurses, as professionals, as practitioners, will be vital to delivery.

By working together it is a programme that we will deliver.

Alan Milburn – 2001 Speech to the Fabian Society

Below is the text of the speech made by Alan Milburn, the then Secretary of State for Health, on 21 October 2001.

Nye Bevan’s shadow hangs over every health secretary, especially Labour secretaries. He was the architect of a care system based on values community, solidarity, and belief that we achieve more together than ever can alone.

Our commitment to the values of NHS binds today’s generation Labour Ministers Bevan generation. And yet our pride in creation last century must not stand way its necessary re-creation for this century. attachment has too often been structures when it should have values. end do change with times. endure over time.

Bevan’s greatest success was not to overcome the intransigence or conservatism of those opposed to creating the new NHS, enormous though that achievement was. It was not to forge a particular structure for the NHS because as Bevan himself later conceded there may have been better ways of organising the new health service. It was neither of these things. His greatest achievement was to build a national coalition behind the values of the NHS. A system based on need not ability to pay, free to all and available to all. A system which removed the fear of becoming ill and having to face the doctor’s bill. The boldest ever attempt to break the vicious circle where poverty brought illness and then illness brought ever greater poverty. These were the right principles then. They remain the right principles now.

But Bevan’s was a structure forged out of the experience of war. It took a particular structural form – state ownership through nationalisation. After all the Second World War had been won by a society committed – after five years of total war – to the notion of collective action to solve national problems. People had made sacrifices in their own lives – many of their own lives – in pursuit of the common good. During the War the values of solidarity and the actions of the State converged. The State was the focal point for the solidarity of the British people.

Conscription meant that everyone had to take common risks. Rationing was treated the same.

And this approach worked. We won the war. And when Labour peace same was applied. took on big national problems by creating institutions. Coal Board – to take over a failing industry. British Transport Commission railway system. Health Service care

In 1948 there were 1.334 voluntary and 1,771 municipal hospitals. A confusion of different systems. No clear standards. No national planning. The NHS brought order out of chaos. It provided the basis for the first time in our history for a national system of health care.

And yet it was far from perfect. Indeed elsewhere in Europe governments, many of them socialist or social democrat, forged institutions which favoured greater community ownership over state ownership. Here in Britain centralised control still means, in Bevan’s famous phrase that when a bedpan is dropped the noise reverberates throughout Whitehall.

Indeed throughout the last two decades of structural upheaval in NHS essential post-war structure top down control has remained largely intact. result been that too often governments have defended interests as a provider services when they should focussed on patients consumers services.

It is right of course that there should be national accountability for the workings of our country’s health care system. For fairness sake there should be clear national standards applied across all parts of the country. It is right too that government should allocate resources to ensure that NHS cash meets health needs.

But beyond that I believe the old top-down model of the 1940s cannot deliver in the twenty first century. Vesting control at the centre has diminished control where it counts – in local communities where local health services interact with local people. In the modern age that will no longer do. For public services to command public confidence today they have to give greater control and more choice to the people who use them,

This is the key challenge we face in government as go about our fundamental task for this second term of reforming great public services: how to reconcile maintenance equitable access all with greater choice individual. policy education example, give parents more school and diversity provision within a framework rising national standards.

In health I believe we can best meet this challenge in three ways. Firstly by reforming the NHS to deliver improved and more responsive services to match modern needs. Secondly, by ensuring patients have more power and greater choice over services. Thirdly, by empowering communities to have greater involvement with local services.

First then modernising health care. People grow up today in a consumer society. Services – whether they are private or public succeed fail according to their ability respond modern expectations. Bevan’s was an era where expectations among the were lower, deference institutions and professions greater. exercise more choices lives than at any point history. Many can afford walk away from which do not command confidence. one nation Britain cannot be built on two tier care but failure deliver big improvements NHS will if we careful inevitably make case for

The way NHS services were provided in Bevan’s generation simply will not do for this generation. People no longer tolerate second rate services, dirty wards, waits of 18 months an operation or hours on a trolley. That why there is such huge effort going to redesign from the patients point view. get waiting times down, make more flexible and convenient who use them. provide easier access, round clock. Alongside problems today progress.

The record investment and far-reaching reforms we outlined in the NHS Plan are beginning to bite. For first time there is a sensible relationship between public private sectors expand care available patients. clear national standards means implement them. real incentives reward good performance alongside help end poor performance. getting health social working together rather than against each other.

And yes, progress takes time. The problems remain in the NHS but today the NHS is the fastest growing health service of any major country in Europe. This year there are 3000 more NHS heart operations. Prescriptions for drugs to prevent heart attacks are up by a third on last year. People with suspected cancer, who used to wait for months to see a specialist, are now being seen within two weeks. There are more beds in hospitals this year for the first time in thirty years. New hospitals, more staff, new equipment – are all coming through at record rates.

But investment alone will not do the trick as today’s Audit Commission makes very clear. Making progress is not just a question of resources but of reform. So whilst we will invest
£100 million to reduce waiting times in A&E that must be accompanied with organisational improvement in individual departments and management change across the hospital.

At the heart of public concerns about NHS is sense that its services are simply too indifferent to needs patients. Staff and patients alike up against a system feels much like 1940s. confidence demands fundamental change not just in level investment but culture today – put parents pupils first schools hospitals surgeries.

That brings me to my second point: a health service designed around the needs of patients must give more power patients. Better education, greater leisure opportunities and easier access information mean that people today are less likely accept passive role as recipients care. Crucially meet’s expectations, NHS, true its values, offer not just fairness but choice.

The NHS has always been strong on fairness but weak choice. It was born into a world where everyone given the same rations. In top down model there rationed care, capacity shortages and culture of paternalism, strove for equity population at expense choice individual. Today we have an opportunity to reconcile As expands its capacity, our task – make investment reforms necessary over months years ahead – is demonstrate that can expand without compromising equity.

That is why we say choice in health care should not be about forcing patients to pay for their own care. privatising NHS services. It expanding capacity and reforming can only happen with a greater plurality of provision through longer-term relationship between the public, private voluntary sectors providing more patients.

In other words what we must not do, as we seek to embed choice within the values of the NHS, is to abandon equity. We must not throw the baby out with the bath water. Let me give you an example. Some commentators argue that patients getting access to hospitals only via GPs limits choice. The truth is, however, our list-based GP system is not only genuinely envied abroad, it enjoys high satisfaction levels among patients at home. It brings major health benefits through continuity of care. It engenders high levels of trust between patients and professionals. And it manages the 90% of common illnesses better and cheaper than a hospital ever could.

But even here we need to make changes get a better balance between choice for the individual and fairness society as whole. Patients can already choose their GP but there is limited information about choices open them. improve on that by ensuring primary care trusts available people in local community they serve availability of services, specialisms female GPs, alongside data waiting times other aspects performance. provide bigger range services cater different lifestyles choices. More GPs who specialise treating particular diseases. NHS Direct advice treatment. Faster surgery appointments. walk centres where lack instant access.

Crucially, modern GPs should not just be gatekeepers. They should be navigators, guiding patients through the system and helping them make informed choices about their care. And here there is much more we can do to improve choices for patients. When we abolished the internal market in the NHS we restored GPs’ rights to refer patients to different hospitals. In most places though there is only one local hospital. That is why we have to raise clinical standards and cut waiting times in every hospital. From all the evidence I have seen, at home and abroad, the fundamental choice patients want to see is the choice of access to a good local hospital. Unlike the Tories’ botched internal market this is Labour’s primary objective. Over the last four years we have developed an array of means to deliver that – including cash that is tied to outputs and now a ratings system that gives greater freedom to the best performing hospitals and that franchises the management of the poorest performing hospital.

These levers are producing change. But the problem is they all top down. entail hospital responding to centre when what hospitals need be able do respond patients. So alongside these we should give patients greater choice over location of their treatment as another more direct means getting directly in other words not just about making patient feel good NHS. It giving power

From April next year patients will have more power. Any patient who finds their operation is cancelled at the last minute and are not then re-admitted within 28 days be able to choose an alternative hospital for treatment. They can public or private NHS pay there. This act as a powerful incentive hospitals improve performance on operations which causes misery frustration staff.

As capacity grows in the NHS we can now consider how to extend this choice principle to other aspects of hospital care. By March next year 5 million patients will have already chosen dates for hospital appointments convenient to themselves. By 2004 two thirds of all in patients and outpatients will be booked at the convenience of the patient not the system. By 2005 all patients will be in that position. And by then of course waiting times should be much lower.

Even then some patients will find themselves stuck with a longer waiting time at their local hospital than is available in other hospitals. London today for example the average all inpatient specialities varies between 7 weeks and 23 weeks. If we could extend choice of particularly to those who wait longest it would give patient greater control over own times treatment. Provide another incentive hospitals improve performance.

At present it is difficult for patients to choose opt a shorter waiting time. The way hospital funding rules work, deter rather than enhance patient choice. Many cannot exercise choice because they travel far afield. And there limited information available – or their GPs on times in different specialities hospitals. We are examining how these blocks can be removed I will bringing forward proposals near future.

Some within the NHS will see it as a threat. I can understand that. It is certainly a big change. But I believe it is the right thing to do. Today the patient has to be in the driving seat of change.

This brings me to the third point I want make: an NHS that is open choices by local patients must be better able respond needs of communities. way was set up took ownership away from It invested instead in State. course brought huge benefits. But there a cost. gulf grew between communities and running services. Today we find bridge it. all know strength feeling retain for their health You can see when walk into any hospital are met team volunteers drawn community. formal structures need embrace community support rather than keep at arms length.

I believe a key task for this second term is to reconnect public services with the communities they serve.

The wider social determinants of ill health – from poverty to poor housing call for the NHS be actively involved with others in local community improve and tackle inequalities. By devolving power frontline services most notably primary care trusts there is now an opportunity public re-engage communities they serve.

Devolution will help re-engage NHS staff too. The NHS is a high trust organisation. It works on the basis of trust between patient and professional. In the way it is organised it needs to enshrine that trust by giving more control to frontline services where patients and professionals interact. The simple truth is the NHS cannot be run from Whitehall. It employs over one million people. Improving services relies on them having a greater say over those services.

That is why we are slimming down tiers of management above the NHS frontline. It’s devolving resources to locally run Primary Care Trusts. Within three years they will control quarters budget. want unleash a spirit public sector enterprise that can rival any private enterprise. framework new national standards have established, use commitment and know-how staff improve for patients. give local freedoms innovate, develop services.

Patients should be at the heart of this process. present structures for giving patients a voice in NHS – most notably through Community Health Councils lack teeth and are out date. Just as reform is needed elsewhere here too. Alongside our plans forums to strengthen say local communities have over services we also need consider how can build on flowering experiments with citizen juries panels that has taken place recent years. I now asked Nigel Crisp, Chief Executive, work managers best Trusts advise me concept earned autonomy could relationship between they serve.

There is an analogy here with developments in urban planning the 1960s and 1970s which were supposed to usher a golden age of housing. That too was era expansion extra investment. Huge sums invested tower blocks council estates. intentions good. But outcomes – as we all know not. Estates became rundown almost quickly they put up, destroyed communities when intention create communities. Investment failed to deliver a new dawn social. It because people who be its residents never involved creation.

That’s why the relationship between citizens and public services in this 21st Century should be based on principles of decentralisation and empowerment. In health, in education, in housing, in local government and elsewhere we need to decentralise and empower staff and citizens alike. We must decentralise from the nation to the region. We must decentralise from local councils to local schools and to local housing estates. And in the NHS we must give communities more voice as well as giving patients more choice.

Our agenda for government must be about empowering citizens as well providing first class public services. It have at its heart a commitment to involvement much investment; reforming the way we engage deliver services; decentralisation key part of delivery.

For this generation of Labour Ministers our commitment to the values NHS must mean creating a more direct relationship between public and their services than was possible – or even conceivable in Bevan’s generation. That will require some big reforms. We need look at how can forge new settlement patients, professionals service. To open up choices for patients and recast structures so control means something simply state control.

Nye Bevan would not have been afraid of any these changes. For Nye winning elections was about gaining power over society. It using to change Indeed his whole philosophy summed up in that one phrase: “the purpose getting is be able give away.”

In conclusion then, I believe that just as the weakness of free markets are now clear, the shortcomings of monolithic, paternalistic public services are self-evident. Our answer is not just a stream of extra investment but a strategy of fundamental reform. To reshape public services, safeguarding equity of access whilst empowering the individual; to decentralise from Whitehall, ensuring greater local accountability within a framework of national standards. To deliver consistent quality and patient choice within an NHS which itself has more plurality of providers. This is an ambitious agenda for public service reform. It is an essential programme for this second term.

Alan Milburn – 2001 Speech to the Annual Social Services Conference

Below is the text of the speech made by Alan Milburn, the then Secretary of State for Health, on 19 October 2001.

I want to set out today some of the improvements we have seen in the last year, some of the challenges we now face and the further progress we can now make.

There is today a shared agenda between local government and central government. A shared vision for social services and, I hope, for the wider public services. That is a vision of services designed around the needs of the user, rooted in the values of community.

In education: where pupils come first in highly performing local schools at the heart of their communities.

In health: where patients come first in hospitals and GP practices serving the needs of their communities.

And in social care: where the vulnerable adult or child come first in safe and sound community services.

In all of these areas local government is a valued and valuable partner. I strongly believe that should continue to be the case.

We have a shared agenda too, for improving quality in care. For services that offer fair access to all and which help promote opportunities for all.

I want to thank you for the contribution you make to the fairer society we want to create. People who work in social care – and those responsible for managing social care – do so under real pressure. You are on the front line of many of the major challenges which face our country today – addressing the problems of poverty and deprivation, a growing elderly population, and growing public expectations too.

And in this time of international tension, I want to place on record my gratitude for the work of local government – officers and members – in emergency planning and preparation. Your local contribution is vital to our national vigilance.

Meeting these challenges must sometimes seem like a Herculean task. Sometimes – often – there is scant thanks for what you do. And yet just a few months ago when people faced the choice in this country between short term tax cuts and long term investment in public services, the public of this country backed public services and they backed the people working in them. I think we should all take heart from that.

Today people know a fair society, where everyone in our communities and not just some get a fair chance, can only be built on the sure foundations of a strong economy and strong public services.

There can be no such thing as a fair society – or a strong economy – if the education system is geared to success for some but not for all, or if whole communities are laid waste by the ravages of drugs and crime. And we certainly cannot have a fair society if health and social services deny people help when they need it, where they need it.

We all know today we are a long way from having public services to match Britain’s position as the fourth largest economy in the world. We know too that the public are impatient for change. Some people say public services can never deliver, that private provision is the only answer for problems that are self evident.

I say that on grounds of efficiency and equity that view is wrong. But I say with equal firmness that failure to deliver reform in public services will prove the doubters right.

Delivering improvements in public services – in all aspects of our public services – is not an optional extra. In these next few years progress must be made – and be seen to be made – in all of our public services if we are to sustain progress towards the fairer society we seek.

There are good grounds for optimism. For a start the investment is going in. In health and education, with the NHS today the fastest growing health care system of any major European country.

In social services investment is growing too. I know there is real pressure on your budgets. I know that that’s true for children’s care and as well as elderly care. And that is why we responded just last week with a further £300 million of new funding for social care. It brings growth in social care budgets up to 3.7% in real terms next year compared to growth of 0.1% a year prior to this Government coming to office. I know we have not solved every funding problem. But we have made progress – and we will go on making progress.

I want to give you an example of one area of progress. Let me give you one example of progress. For years, politicians and newspapers blamed social workers for just about every ill our country faced. So, it is progress when I can come to this conference and say without equivocation: we need more social workers in this country not less.

That’s why today we are launching a three year social work recruitment campaign with a view to an extra 5000 social worker. I know that shortages of social care staff are biting hard in many parts of the country. But these shortages can be turned round. The nurse recruitment campaign we have run in the health service over the last few years has proved that. Last year at your conference I was able to provide extra cash to help students train for a career in social work. Now the recruitment campaign will set out the positive benefits of a social work career to help counteract the all too frequent negative coverage the profession receives in the media.

Expanding staff numbers and investing in frontline services then are the pre-conditions for improvements in social care. But investment alone will not deliver. The courage to invest must be matched with the courage to reform. And the courage to tell the truth about how things really are.

While I see real beacons of excellence in social services – just as there are real beacons of excellence elsewhere in public services – the best has not been available to the many: it has all too often only been available to the few. What is more, the needs of the service user have all too often come a poor second to the needs of the service provider.

In the modern world that will no longer do. To command public confidence our public services today have to offer choice as well as fairness to those who use them.

All the money in the world will not deliver these changes. Indeed, there is a danger that simply pouring more money in without linking it to reforms will ossify ways of working, embedding attitudes and structures that are long overdue for change.

Reform in social services then is as vital as reform in any other area of our public services. And just as in health or in education there are four main principles which underpin the reform programme:

First, high national standards and full accountability

Second, devolution to the front line to encourage diversity and local creativity

Third, flexibility around the needs of users in how staff are employed and how services are organised

And fourth, the promotion of alternative providers and greater choice.

So how should this programme apply to social services? Before I answer that, let me just say this: I know change is difficult – I know that there are real pressures out there – but it really must happen. Whether it is the exceptional high profile service failure or simply the day-to-day reality of unresponsive services, public confidence cries out for change.

We should be confident that we can meet the challenge of change. There is much to be proud of and much on which to build. The work we have done together in bringing in the Quality protects programme with its focus on the needs of the most vulnerable children, the General Social Care Council, the National Care Standards Commission testifies to our shared commitment to improvements in social care.

So let me begin with standards and accountability.

People have the right to know that they will get certain minimum standards wherever they live. And I am pleased to come to this conference today and report real progress. Today I am publishing the latest set of social services performance indicators. They cover performance over the last three years.

Compared to last year, 20 out of 23 indicators show either improvement or a continued high level performance.

More older people than ever before are being to helped to live in their own homes rather than in care homes.

The number of children adopted has risen again giving them the chance of a stable family life.

Compared to two years ago there are 850 more children who have found permanent adoptive families – well on the way to meeting our ambitions for a 40% increase by 2005.

I really do want to congratulate you for the progress being made. But as ever, there is much more to be done. It should concern us all that the target on delayed discharges was missed. That means people are being kept in hospital when they should be at home. There was a slight improvement this year it is true, but with the new money I announced last week for social services specifically to address the “bed blocking” issue, I expect to see significant improvements during the course of next year.

Similarly, more than 6 in 10 children are still going out into the world from care without a formal qualification. None of us would be happy with that for our own children. It is also unacceptable that only one quarter of councils reviewed all their child protection cases on time.

What is crystal clear from these tables is that there is excellence in our social services. But it is excellence spread too thinly. It is available only to some when surely our ambition as a nation must be to make it available to all.

Of course local services should be attuned to the needs of different local communities. That is why we have locally run social services. But right now, as these tables show, the variation in performance across social care is just too great.

Take London for example where there are particular problems with cash pressures and wide societal pressures. In one part of the City fewer than one in five children leaving care had a qualification. In another part almost 6 in 10 had. In one part of the North only 2% of looked-after children were adopted while in another part five times that number were. In both examples, alongside countless others, the councils concerned have similar locations, deal with similar problems of poverty and deprivation and have similar levels of funding.

These tables remove the excuses for unacceptable variations in performance. This is not primarily about money. It is about management and organisation. And that is the value of these tables. They expose those areas where performance needs to improve. I know there will always be arguments about the details in the tables and the methodology behind them but for me – and I hope for you too – there is a simple principle at stake here – the public who use our public services have a right to know how well those services are doing in comparison with others.

Public services don’t belong to me and they don’t belong you to either. They belong to the public. Accessible information for the users of public services is essential if we are to design services around the needs of users. That is what we are doing with schools and hospitals. And it is what we must now do for social services.

I know that current tables are far from perfect and are far too complicated. So I can announce today that we plan next year for a new approach which will provide more easily accessible information to the public about social services performance. From next year, we will bring together the existing performance data with information from inspections and in-year monitoring. The result will be a more rounded assessment of each council’s performance.

Just as we have recently done for hospitals this year, so from next year each council will receive a star rating for its overall social services performance. There will be separate ratings for adult and children’s services. We will work with the LGA and the ADSS on the details of the new system. I believe profoundly that it will help councils to improve their performance.

That brings me to the second part of the reform programme – devolving power and encouraging diversity.

Providing information to the public is just the first step. Being able to act on it is what counts. Action should follow assessment. Where there is good, bad and indifferent performance so different approaches are clearly needed.

Where there is good performance we should step back. Where there is poor performance we should be prepared to step in. We should offer more rewards for the best performers. And more help to turn around the poorer performers.

One of the greatest frustrations I hear expressed in the NHS and in social care too is that all too often rather than rewarding the good we simply bail out the bad. That is what we now must change if we are to provide the right incentives for improvement in all aspects of our social, and indeed all, services.

So beginning with this year’s best performers – including the top ten consistently high performing councils in Derby, South Tyneside, Sunderland, Derbyshire, Cornwall, Rotherham, York, Salford, Dudley and Leicestershire – in future all of them will get the greater local freedom they have earned.

We will invite the best performers to discuss with us how they could have greater control rather than less. We will explore with them a lighter touch inspection regime with non-children’s services being inspected, perhaps only every five years. We will consider removing the conditions attached to special grants so that top social services authorities are free to spend their money in ways they decide can best make the improvements in services for the communities they serve.

And we will give the best star rating performers their share of next year’s new £50 million performance fund to spend as they think fit. Some could go on staff bonuses. Some could go on developing new services. The point is that it will purely be a matter of local discretion.

The point is that good performance will earn the devolution of power. This new approach will not only reward success among the best it will encourage improvement among those who could be better.

The performance indicators show every council is doing well in some areas. Some authorities while not yet the best are improving and improving rapidly. Councils such as Cambridgeshire and Newcastle upon Tyne deserve special praise since they have only recently come out of special measures and they are making record improvement. We now need to make sure that every one of them do even better and that others can learn from what they have achieved. We will look to the Social Care Institute for Excellence as it develops its role, to disseminate and embed good practice.

I can announce today that we will consider using a part of the new Performance Fund to allow the fastest improvers to spread the benefits of their knowledge to others that are in most need of improvement.

For the few who are genuinely poor performers – including the bottom ten of the Isles of Scilly, Richmond on Thames, Buckinghamshire, West Berkshire, Windsor & Maidenhead, Kirklees, Torbay, Bracknell Forest, Warwickshire and Lambeth – I believe that different action is needed. We already have mechanisms to deal with poor performance including the powers to put Councils on special measures. There is evidence that performance does improve when the SSI is closely involved. But sometimes delivering improvements simply takes too long. So I can say today that I will act using Best Value and other intervention powers where the evidence suggests the pace of improvement is simply too slow.

I will also be discussing with the LGA, and with Stephen Byers at the DLTR, how we can use external expertise from the voluntary, statutory and private sector to turn round performance where local social services are persistently failing or falling behind.

We will want to explore in particular how to encourage the best performing local social services to take over responsibility for running the worst. I want to encourage in social care, as much as we are trying to do in health care, the development of a new public sector enterprise culture where we get the best people in public services to lead improvements across the rest of our public services.

So, today I am putting this year’s worst performers on notice:

First, they will be required to agree with the Chief Inspector an action programme for improvement.
Second, special measures will follow if services do not improve.
Third, by the time we award star ratings next summer, if performance and prospects for further improvement remain poor, I will consider using other intervention powers.
In some cases I know that social services management can struggle because there are problems at the corporate or even the political level. If I find evidence of corporate failures limiting social services delivery I will consider triggering corporate inspections so that we can find where the problems lie so then we can tackle them.

Where councils and the NHS are not working together effectively, I will consider asking the SSI and CHI jointly to investigate the reasons for partnership problems. If necessary I will use my powers to compel local health and social services to work more effectively together.

That brings me the third strand of the reform programme – building services that are flexible enough to meet the needs of their users. The painful truth about the way we organise care is that it is like a maze for too many of its users.

There is confusion and uncertainty about where the responsibilities of health and social care begin and end. Too often people who rely on these services – whether they are elderly or disabled or have a mental illness – find themselves faced with an endless procession of staff carrying out roughly the same assessments. And then of course there are turf wars over who funds what and who does not.

I know there is a monumental effort going into all parts of the country into improving partnership working both in health and in social services. I want to thank you again for the progress you have made. We saw the results of that last winter. I hope we can see it again this winter. Where partnership works it works brilliantly. Where it does not the needs of the user come a poor second to disputes between services.

And let me just say candidly, I know the problem lies as much on the NHS side of the fence as on your side. The answer is to take down the fence. I believe we now have the means to do so.

From next year we will be putting in place a single process for assessing the needs of elderly people for health and social care. I hope that can be accompanied by fewer demarcations between staff to build on the pioneering work in places like Wiltshire where social workers and community nurses work as a single team.

Greater flexibility between staff needs to be matched by greater flexibility between organisations. Frankly, so far I have been disappointed by the take up of the legal powers, which are now available, for health and social care to pool their budgets and work more closely in partnership. I will be looking for faster take up of these powers in the year ahead, towards our aim of having them used in every part of the country.

What the bed-blocking problem in the NHS reveals is the simple truth that social services and health services sink or swim together. Each needs the other. The older person needs both. What we have to move to then, is one care system. Not by takeovers but through partnerships.

Today, I am pleased to be able to confirm that next year the first of up to fifteen Care Trusts will come on stream, bringing together in a single organisation health and social services for older people or for people with mental health needs. Eventually, I hope Care Trusts will be in place in all parts of the country because they break through bureaucratic boundaries in order to focus on the needs of service users.

That brings me to the final part of the reform programme – promoting greater choice and diversity in provision. In social care diversity of provision has already taken hold. Over 80% of residential care and over 50% of home based care is provided by the independent sector. Some of the best learning disability services are run by voluntary organisations.

Yet for too long, in my view, there has been a stand off in the relationship between the statutory, private and voluntary care sectors. There should be no ideological barriers getting in the way of the best care for vulnerable people.

Last week, I hope we saw the beginning of the end of that stand off with the publication of the ground breaking agreement between the Government and representatives of the NHS, local councils and independent sector providers in housing, health and social care. The document we published, “Building capacity and partnership in care”, marks a decisive break from the short termism of the past. It sets out principles and practices to underpin what I hope will become a more mature long term relationship between the public and private care sectors.

The recent losses of capacity in the care home sector call for such a relationship, with longer term contracts between councils and care homes. They call for the independent sector to have a seat at the table for planning future provision. They call for public and private sectors to work together not just to shore up existing provision in care homes but to develop new services in people’s own homes: intensive home care packages; new more active intermediate care where the emphasis is firmly on rehabilitation and independence. All of this is about providing more choice for users by promoting greater diversity in provision.

The £300 million we announced last week to deal with the problem of delayed discharge will translate the Agreement into action. This is a cash-for-change programme. We want to see real change to eat into the bed blocking problem. By the end of this winter, we want to see 1,000 fewer older people stuck in hospital at any time, that way we can release 1,000 extra beds for other NHS patients. Next year we will want to see further progress still towards our aim of ending widespread bed blocking by 2004.

Together, people working in health and social services are at can bring about these improvements. They can do it providing they seize the opportunities which now exist to reform these services.

For too long, social services have been undervalued in our country. Blamed when things go wrong. Ignored when things go right. Often expected to fail. Sometimes set up to fail.

So, let us make a fair assessment of social services in our country today.

Investment is now rising and performance is improving but there is much more that must be done to put the needs of the user at the centre of the service.

To do that, the best in social services must help reform the rest of social services. The old barriers, which divided health from social care, and separated public from private provision, must now be overcome.

The poor performers must receive direct support to do better.

The big improvers must spread the lessons of improvement.

The best performers must have new freedoms to be better still.

None of this is easy. Much of it will take time. All of it requires a huge amount of effort. This is a reform programme based on our belief in public services and our belief in social services. It is based also on our belief that these services can be better – and must become better than they are today. And most of all, we believe they can be better than they are. What we must now do is demonstrate we can deliver. We’ve made substantial steps forward – we need to build on that and we need to deliver. The public expect no less.

Alan Milburn – 2001 Speech to the NHS Confederation Conference

Below is the text of the speech made by Alan Milburn, the then Secretary of State for Health, on 6 July 2001.

The NHS is a graduate of the school of hard knocks. You only have to read a few of the daily newspapers to know that. The NHS was born in the face of fierce opposition. Today, still facing opposition from some quarters – some opposed to NHS principles, some opposed to NHS reforms.

Those of us who are wedded to those principles, who believe in those reforms, should draw confidence from them. For me, I have never been more confident about the NHS:

– the people working in it;

– the ethos they espouse.

And more confident about its ability to deliver far reaching improvements in the care it provides to patients.

My confidence stems from meeting people like those who received awards last night; ordinary people doing an extraordinary job, making reform happen in the work they do each and every day.

And when people had a choice at the General Election a few weeks ago, they backed public services and they backed the people who work in public services.

Today people know a fair society, where everyone in our communities- and not just some – get a fair chance, can only be built on strong public services alongside a strong economy. There can be no such thing as a fair society – or a strong economy – if the education system is geared to success for some but not for all. There is no such thing as a fair society if whole communities are laid waste by the ravages of drugs and crime. Above all else, we cannot have a fair society if health care denies people help when they need it where they need it.

In the five weeks of the election campaign I met staff and patients up and down the country. I visited good places and some less good places. I heard what NHS staff had to say. I saw what they were trying to do.

As a Health Visitor said to me on one visit, “it definitely feels better but it does feel like rolling a big boulder up hill.” There is an enormous effort going on throughout the NHS to bring about the improvements both staff and patients want to see.

As the election showed all too clearly people will no longer tolerate second class services. They will not put up with dirty wards or sluggish services. They quite rightly want health services which are responsive and which put their needs first. As we all know for too long the NHS has not been able to meet these tests. And people are impatient for improvement. The stakes are high for all of us who believe in the NHS.

Delivery – bringing about visible improvements in services – has to be the priority. A failure to deliver reform in the NHS will play directly into the hands of those who say that the NHS can never deliver.

The debate on the NHS has moved on. For years it was all about the need for more investment, since for decades the NHS had suffered under-investment. Today we are putting that right. With funding growing at twice the rate of the past the NHS is now the fastest growing health service of any major country in Europe. And because sustained investment will continue throughout this Parliament the debate on the NHS is now very different from what it was just a few years ago. It is now about whether even with this enhanced level of resources the way we organise and fund health care in this country can ever deliver a modern patient-focussed service. And you only have to read the comment sections of some of the daily newspapers to know that waiting in the wings are those who say that the fundamental principles of the NHS cannot work and must be abandoned.

I believe those newspapers are wrong. I believe those politicians on the Right who advocate their cause are wrong. I have a different set of beliefs. I believe in the NHS – in its principles and, above all, in the people working in it.

People do not work in the NHS to make a mint for themselves. They work in the NHS to make life better for others. It is the ethos of public service – its burning ambition to serve people regardless of their wealth or worth – that lies at the heart of public support for the NHS. It is the ethos of public service that can light the way to a fairer, more decent society in Britain today. But just as surely as it is that ethos of public service that makes the NHS, losing that ethos would break the NHS.

We risk the ethos of the NHS, its values and its principles, at our peril. That is why we say while we will forge a new relationship with the private sector, it is just that: a relationship, not a takeover. NHS values are not the same as private sector values. Health care relies on trust between patients and professionals. The fundamental reason the NHS is still trusted by patients today is because they know that decisions about their treatment are based on the scale of their needs not the size of their wallets. You only have to look across the Atlantic to see what happens when frontline health care is compromised by a clash of motives. Trust is lost. Competition replaces co-operation. Two tier care develops. In America, 40 million people have no health care cover whatsoever. A free market in health care does not work.

It is not the right way forward for health care in Britain. NHS values are British values – compassion, fairness, a belief in the strength of community, co-operation with others as the basis for individual progress. It would be folly to sacrifice these values and these principles. So while some subscribe to the philosophy that all things private are good, all things public are bad I say: that philosophy belongs not today but to yesterday.

There is no saviour of the NHS other than the NHS itself. But we do need every bit of help we can get to renew the NHS. That’s why we will not close our minds to the NHS and the private sector co-operating where private sector expertise or finance can bring benefit to NHS patients. The point is to define the nature of the relationship – what it is and what it is not. It is not about creating a mixed economy of care. It is about maximising the care that is available to NHS patients, based on NHS principles.

Some have said our proposals are too opaque. I say we have taken a hard look at where the private sector can help. First, using spare capacity in the private sector, such as in private hospitals, to perform operations on NHS patients. Second, getting private sector management to run some of the new stand-alone surgery centres our Manifesto commits us to building and which will specialise in precisely those procedures where private hospitals have some expertise. Third, extending PFI beyond the hospital sector where it has already helped deliver the biggest hospital building programme the NHS has ever seen into new PPPs in primary care, social services and the provision of equipment. And fourth using private sector management expertise such as in the provision of IT systems.

It is around these four activities that we will forge a new relationship between the NHS and the private sector. This is not privatisation – the taking of services out of the NHS. It is bringing into the NHS private sector help in those areas where it has a track record and where there are benefits for patients. The private sector will help but the NHS is – and will remain – Britain’s dominant health care provider.

It is for this reason that reform in the NHS has to come from within the NHS. It has to be led by the managers, doctors, nurses, therapists, scientists and all the other staff who hold the knowledge and the skills to improve services for patients. The best in the NHS making sure the best is available to all who use the NHS.

Reform from within is not an easy option. It means grasping nettles that for too long the NHS has failed to grasp. It means big changes – in the way the NHS is organised and in the way NHS staff work. It means overcoming old boundaries between services and traditional demarcations between staff. It means changing the relationship between NHS services and NHS patients. In all these ways reform is already underway. It is being led by NHS staff. It strengthens my belief that there is nothing wrong in the NHS that can’t be put right but what is best in the NHS. The test for the NHS today is to prove it can make these changes from within, not just in some services and in some places but for every patient, everywhere.

The choice for all those who care about the ethos of the NHS is straightforward: to stand on the sidelines carping, as some do, or to join in the process of reform as thousands of NHS staff are already doing. We will work – I will work – with all of those who genuinely want to make reform happen. But I say to those who would stand in the way of reform: there must be, there can be, there will be no veto on reform any more than there can be a veto on the pace of reform. The best way of supporting the public service ethos is to support public service reform.

Reform is difficult. There may be a rocky ride. Reform is a risky business as well as a rewarding one. Sometimes we’ll get things wrong as we try to put things right. That’s what leadership is all about. You know that in the organisations you lead – there is no improvement without innovation, no innovation without risk.

But we have to take the risks, make the changes, earn the improvements now because the clock is already ticking. Now is the time – with the foundations laid from our first term and a clear mandate for delivery in our second – to up the pace of reform. Not because we can promise an overnight transformation but because we know that we need to deliver progress towards that transformation. Patients and the public alike will stand for nothing less.

The NHS Plan is unashamedly long term in its ambitions. Expansion in staff and improvement in services takes sustained time and sustained effort as well as sustained resources. And we should all be clear about one thing: public confidence demands real progress – not just over this whole Parliament but over these next few years.

That calls for an absolute focus on what matters most to patients. How long they wait. The standards of care they receive. The sense that theirs is the only vested interest that counts in today’s NHS.

We have made a start – and I want to thank you for what you have done. In managing change, in navigating last winter, in making expansion happen. But now we must go further and we must go faster.

There is a big agenda to implement. The NHS Plan is an ambitious plan for improvement. I know it can’t all be done at once. There are some things that are more important than others.

Today I can set out to you the five areas where progress should now be focussed. These five are what matter most to patients.

First, on the conditions with the greatest clinical priority – cancer and heart disease and services for the elderly and those with mental illness. Rehabilitation services to build a bridge between the hospital and the home. Prevention and treatment services that improve outcomes and tackle inequalities. By 2005 we will be spending an extra £1 billion a year on cancer and cardiac services alone. Our ambition is to give our country levels of cancer and cardiac care that are no longer behind the rest but up with the best in Europe.

Second, primary care – the point of contact most patients have with the NHS. GPs and other staff are doing a good job under real pressure. That is why our priority has to be to increase the number of GPs as fast as we are able alongside expansion in nursing and other primary care professions too. And it has to be about getting extra investment directly to the frontline in primary care both to improve services for patients and to relieve pressures on staff. Together with the reform programme outlined in the NHS Plan – more specialist GPs, more personal medical services, a new GP contract – this investment will help give patients easier access to primary care services.

Third, emergency care – the point of contact patients most need to know is there for them when they require it. We will invest more in ambulance services, in accident and emergency departments and in expanding NHS Direct. We will also work to integrate these services so that better, faster care is there for patients. Far-reaching reforms and a better division of labour amongst clinical staff will, by 2004, have reduced average waiting times in accident and emergency departments to 75 minutes. Inappropriate trolley waits for admission and assessment will by then have been ended.

Fourth, cutting waiting times. The biggest concern about the NHS today is how long patients wait for treatment. It is frustrating for staff and distressing for patients. So building on what has been achieved to reduce waiting lists in our first term, our focus in this second term will now move on to reducing waiting times for treatment. In primary care. For ambulance services. In outpatients clinics, for inpatient treatment and in accident and emergency too. Today I am allocating £75 million to take forward reforms in orthopaedic, dermatology and ENT services so that patients do get better, faster treatment.

Fifth, getting the fundamentals of care right. Focussing on the patient experience to make sure that the wards are clean, the food is good, the care is there. That the buildings and equipment look good and feel good for both patients and for staff. That patients have more information and more influence over the services that they use.

Our priority then is simple: it is not an avalanche of new initiatives. It is delivery. To deliver progress on the NHS Plan. To deliver faster waiting times. Higher standards. To prove to public and staff alike that the NHS can be a service of first choice, not last resort.

I cannot make this happen. I don’t treat patients. I don’t provide GP services. I don’t manage NHS hospitals. You do. There are only one group of people who can transform the NHS. The people here today. The people in the service. The managers who lead change. The chairs and non-executives who can engage local communities in change. The frontline staff who are the key to change.

Delivery depends on more than a million people. Without them – without you – it simply will not happen. Right now NHS staff are working under real pressure. That is true in GPs surgeries, in community services and in hospitals too. Frontline staff – doctors especially – are feeling the strain. I know that. And I know we need to take action to address that.

Your top management priority is to engage with your staff – to support them so we can get more staff at the frontline and keep them at the frontline – to help them through the process of change so they can exercise power at the frontline.

First, then more staff and more support for staff. Here progress is coming through. What is more it is set to accelerate. The cuts in nurse and GP training places that took place in the 1990s have been reversed. Indeed, there has been a 40% increase in nurse and midwifery university places. There are also more scientists, more therapists, more doctors in training than ever before.

This year the NHS training budget is rising by 11%, the largest increase the NHS has ever seen. Investment in training will help sustain an unprecedented period of growth in NHS staff for a decade or more.

In the more immediate term, the NHS recruitment campaign is bearing fruit. Over 8,000 nurses and midwives – who left the NHS – have returned in the last eighteen months alone. And the campaign is now being targeted at groups like radiographers, midwives, clinical scientists.

Year by year to 2005 we can now be confident that the number of staff working on the NHS frontline will rise sharply. By then there will be 20,000 more nurses, 10,000 more doctors, 6,500 more therapists and scientists.

The corner is being turned on recruiting staff. We will maintain our efforts but our focus must now be on retaining them.

The biggest asset we have in the NHS is the one million people we employ. I know the newspapers are often full of stories about bad doctors. But we know that the NHS is full of good doctors. And good nurses, midwives, health visitors, scientists, therapists, cooks, porters, cleaners – and all the other staff who make the NHS tick. Our job is to get the best from all of them. Improvements in the way we treat patients can only happen if there are improvements in the way we treat staff. Our focus should be on removing the barriers that stand in the way of staff achieving their full potential.

We can’t get the best from staff if the NHS continues as an old-fashioned and rigid employer. Nowadays there is growing demand for more flexible employment from staff. Part time employment is becoming more popular. Some NHS employers have responded well to these changes. Others have not. Within two years every NHS employer will need to offer staff flexi-time, annual hours, flexible retirement or career breaks. The NHS has to be a more flexible employer if it is to become a model employer.

We won’t get the best from NHS staff if they are not helped to balance their family and their working lives. We know that 25,000 nurses alone say that help with childcare would encourage them to return to the NHS. That is why our manifesto commits us to extra investment in childcare. On top of the £30 million a year we are already pledged to invest by 2004 we will be investing an extra £100 million in improved childcare for staff.

As an organisation – in every part of the organisation – the NHS must now focus on removing those barriers that stand in the way of NHS staff being able to do their best for patients. Staff deserve to be valued – and to feel valued. That way we will get more staff at the NHS frontline. We will keep them working at the NHS frontline. And we will liberate their talents for the benefit of patients at the NHS frontline.

Our reform programme for the NHS must have as its core purpose an absolute determination to harness the commitment and know-how of staff to improve care for patients. Where staff have been given their heads they have delivered far-reaching change. You can see that in the cancer collaborative programme where joint working between clinicians, managers and patients has already reduced outpatient waiting times by 50% and radiology waiting times by 60%. The collaborative principle and the collaborative process now need to be spread to all parts of the NHS.

This second term is all about embedding far reaching reform in all parts of the health service and in social services too. Reform to reorganise services from the patient’s point of view – to make same day tests and diagnosis for example the norm and not the exception. Reform to overcome traditional demarcations between staff – to release the talents of nurses and therapists and relieve the pressures on doctors. Reform to break down barriers between services – to get health and social care working as one part of one organisation rather than competing organisations.

What we need now to do is to support more staff through the reform process. That is what giving staff protected time to improve their services is all about. It is what the Modernisation Agency and the Leadership Centre are all about. It is what Individual Learning Accounts for unqualified staff are all about. In time it is what the new University of the NHS will be all about too.

All of this is about one thing: to unleash the tide of innovation that exists among staff in every surgery and in every hospital.

With a clear framework of national standards and policies in place from our first term this second term will be all about shifting the centre of gravity to staff at the NHS frontline. The NHS is a high trust organisation. It works on the basis of trust between patient and professional. In the way it is organised the NHS now needs to enshrine that trust. It needs to give more control to the NHS frontline. The NHS cannot be run from Whitehall. Just as schools now have greater control so local health services must now be given greater control too.

Four years ago through the fundholding scheme GPs controlled just 15% of NHS resources. Today through the primary care groups and trusts they control 50%. Our manifesto commitment is to give the PCTs control of 75% of the NHS Budget. Working at the NHS frontline, the PCTs can harness all that is best about the NHS – good managers, strong clinical leaders, clear community involvement. The PCTs need to be the engine of change in the NHS, driving new partnerships with NHS Trusts, with social services, local agencies and the communities they all serve.

So I can confirm today that within two years PCTs will receive direct allocations of cash rather than cash being directed through health authorities. And I can announce today that in future resources for block capital, as well as for revenue, will be directed not just straight to PCTs but straight to NHS Trusts too.

For the first time in the history of the NHS the majority of NHS resources will go directly to the local services which provide and commission frontline care. By 2004 PCTs and NHS Trusts will be receiving at least £44 billion of capital and revenue direct at the frontline.

I want to give the local leaders of change the cash and the clout to get on with the job. That means slimming down tiers of management above the NHS frontline. It means by April next year abolishing the existing 95 health authorities. It means introducing a reduced number – of around 30 – more strategic health authorities with responsibilities, not for hands-on commissioning of services, but for oversight of local services. It means the existing NHS Regional Offices must go by April 2003.

I know this will be difficult to handle. I know it is not risk free. But we have got to get power and resources devolved to the NHS frontline.

What I want to foster is a new culture of public sector enterprise in the NHS to rival the spirit of private sector enterprise. That requires more discretion over how local budgets are spent. It requires fewer directives from the centre. It requires a clearer focus on what is a priority and what is not. And it requires devolution to NHS organisations to be matched by devolution within NHS organisations. Ward sisters to control ward budgets. Matrons to have the power to fine cleaning contractors who fail to keep wards clean. Hospital consultants and other senior clinicians to decide on how new equipment budgets are spent. It requires greater freedoms and more rewards for NHS organisations which succeed. And it requires greater help and more support for those which do not.

Very often the poorest services are in the poorest communities. That cannot be right. So while we will celebrate success, we will encourage innovation, we will incentivise improvement, we cannot stand idly by where there is persistent failure.

Public service reform will be led by public service entrepreneurs. The NHS has bred its own entrepreneurs – people with a track record of transforming local services. I want to give them a bigger stage to apply their talents. That’s why Nigel Crisp was right when he talked yesterday about the best people from inside the NHS having a bigger role in the NHS – not just to turn around the handful of consistently failing organisations but earning greater freedom to make their own organisations even better.

I want to get the best people in the NHS to get the best out of the NHS. Let’s have a bit more confidence in ourselves. We’ve got the best people in the NHS. Reform is already being led from within the NHS. The NHS has the means to improve the NHS. As the awards ceremony put it last night: Together we can.

The people at this conference today are leading change. Now we have to drive it forward: engage with all the staff, work with them, motivate them. Get staff and patients involved in the local modernisation reviews, change how staff work so we can change how the health service works.

Your priority for reform – our priority for reform – is to free the NHS frontline. Not a return to the anarchy of the internal market but a freedom to shape local services in this second term within the clear national framework of standards and accountability we established in our first term. With a reformed Department of Health doing only what it can properly do in an accountable public service. Providing the resources. Setting the standards. Holding the system to account.

I know the Department needs to devolve and decentralise. That is why we have set up an appointments commission so that trust boards are appointed independently and not by ministers. It’s why I have set up an independent reconfiguration panel so that expert managers, clinicians and patients can provide advice to ministers on contested local service changes.

And there is one further aspect to this process of devolution I can announce today. The BMA, the NHS and the Government all want to see a new contract for GPs. Negotiating a new employment contract will not be easy. Negotiations never are. I have come to the view that the process of negotiation will be helped if the NHS rather than a government department or government ministers speak for the employers side of the table. In the end GPs – whether they are independent contractors or salaried employees – work for the NHS. It must be right for the NHS to speak for itself as these negotiations begin. I have therefore asked the NHS Confederation if it would lead the negotiations. The involvement of the NHS Confederation will help ensure that any new contract is both good for GPs and meets the needs of local NHS services and most importantly the needs of local NHS patients. Clearly we need to finalise the details of these arrangements and the NHS Confederation will need to consult on this proposal. But I believe it is the right thing to do and I hope we can get on with it.

Government alone can not change the NHS: real and visible improvement to patient care only happens – is only happening – because NHS staff make it happen. In this second term, NHS staff will be given the power, resources and responsibility to reform the NHS.

There is now a mandate for investment. And there is a mandate for reform. Of course there will always be differences over detail and negotiations over contracts. But I believe there is a natural alliance between NHS staff striving to improve care for patients and the Labour Government striving for sustained investment, far reaching reform and devolution of power to the NHS frontline.

Our commitment – my commitment – is to work with all those who want to see the NHS succeed. It can not be done without you. It can only be done with you.